A non-government entity
Wellpoint Medicare Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Medicare Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Medicare Advantage (HMO) in 2026, please refer to our full plan details page.
Wellpoint Medicare Advantage (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2026 to people living in Select counties in SC. The overall rating for this plan is not yet available for 2026.
It's important to know that Wellpoint Medicare Advantage (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellpoint Medicare Advantage (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellpoint Medicare Advantage (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $275.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Wellpoint Medicare Advantage (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellpoint Medicare Advantage (HMO) plan features an annual prescription drug deductible of $275. For Tier 1 preferred generics and Tier 2 generics, there is no copay when using a preferred retail pharmacy or standard mail order. If you use a standard pharmacy, Tier 1 copays range from $5 to $15 and Tier 2 copays range from $10 to $30 depending on the supply duration. Brand-name and specialty medications require coinsurance rather than flat copays. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs require a 30% coinsurance at preferred, standard, and mail-order pharmacies. Tier 5 specialty drugs are covered with a 29% coinsurance for a one-month supply.
Additional Benefits
Wellpoint Medicare Advantage (HMO) offers comprehensive coverage with no copay for primary care visits, while specialist visits require a $50 copay and no coinsurance. For hospital care, acute inpatient stays require a $450 copay for days one through five, and outpatient hospital services range from no copay up to a $375 copay. Emergency care is covered with a $115 copay, and urgent care carries a $40 copay, both featuring no coinsurance. The plan also includes valuable supplemental benefits, such as routine hearing and vision exams with no copay and no coinsurance. Members receive up to $2,000 annually for prescription hearing aids and a $100 annual limit for eyewear with no copays, though routine dental services are not covered. Additionally, home health services and diabetic supplies are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Wellpoint Medicare Advantage (HMO) partially covers inpatient hospital services with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Acute stays require a $450 copay for days 1 through 5 and no copay for additional days, while psychiatric stays require a $375 copay for days 1 through 5 and no copay for subsequent days.
Outpatient Services See details
Wellpoint Medicare Advantage (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $375 copay and observation services with a $375 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $50 copay with no coinsurance.
Partial Hospitalization See details
Wellpoint Medicare Advantage (HMO) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Wellpoint Medicare Advantage (HMO) plan, featuring a $325 copay and no coinsurance for both ground and air ambulance services. While some transportation services are covered, trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Wellpoint Medicare Advantage (HMO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Wellpoint Medicare Advantage (HMO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $50 copay with no coinsurance. Standard therapies like physical, occupational, and speech therapy have a $35 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellpoint Medicare Advantage (HMO) with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and remote access technologies. However, several supplemental services are not covered, including fitness benefits, health education, in-home safety assessments, personal emergency response systems, and nutritional or dietary benefits.
Hearing Services See details
Wellpoint Medicare Advantage (HMO) covers hearing exams with a $50 copay and no coinsurance for Medicare-covered exams, and no deductible, copay, or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered up to $2,000 annually and OTC hearing aids up to $300 annually with no copays or coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellpoint Medicare Advantage (HMO) with no deductibles and no coinsurance, offering eye exams with a $0 to $50 copay (no copay for routine annual exams) and eyewear with no copay up to a $100 annual limit. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by Wellpoint Medicare Advantage (HMO), with Medicare-covered dental care offered with no copay and no coinsurance, though prior authorization is required. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, fluoride, restorative services, and implants, are not covered.
Home Infusion bundled Services See details
Wellpoint Medicare Advantage (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Wellpoint Medicare Advantage (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Medicare Advantage (HMO) covers medical equipment with no copays across all categories, including durable medical equipment (DME) which has a 0% to 20% coinsurance. Prosthetic devices and medical supplies carry a 20% coinsurance with no copay, while diabetic supplies and therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Medicare Advantage (HMO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and no coinsurance, and diagnostic procedures with a $0 to $100 copay. Diagnostic radiological services require a copay of at least $45, outpatient X-rays carry a $45 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Wellpoint Medicare Advantage (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Wellpoint Medicare Advantage (HMO) with no coinsurance, though prior authorization is required. While some services are covered with copays ranging from $15 to $20, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellpoint Medicare Advantage (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no three-day prior hospital stay required for admission.
Other Services See details
Other Services are partially covered by Wellpoint Medicare Advantage (HMO), featuring a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved