A non-government entity
Primewell Classic (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Primewell Classic (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Primewell Classic (HMO-POS) in 2025, please refer to our full plan details page.
Primewell Classic (HMO-POS) is a HMO-POS plan offered by Louisiana Health Service & Indemnity Company available for enrollment in 2025 to people living in Northwest, Central, and South Arkansas. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Primewell Classic (HMO-POS) 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 Primewell Classic (HMO-POS).
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 Primewell Classic (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 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 Primewell Classic (HMO-POS)
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 Primewell Classic (HMO-POS) plan has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $12 copay at a preferred pharmacy. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Primewell Classic (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services and some primary care visits may have copays between $0 and $350. Emergency services, vision, hearing, and dental services are covered, with some services having no copay, and others having copays or coinsurance. Preventive services, home health, and skilled nursing facilities are included, with copays for some services. The plan also covers ambulance, partial hospitalization, and other services. However, note that some services, like certain dental and vision services, have annual maximums, and many services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Primewell Classic (HMO-POS) plan. For Inpatient Hospital-Acute, you'll pay a copay of $245 for days 1-10, and no copay for days 11-90; additional days, non-Medicare covered stays, and upgrades are not covered. For Inpatient Hospital Psychiatric, you'll pay a copay of $225 for days 1-8, and no copay for days 9-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a copay between $0 and $350, Observation Services have a $245 copay, Ambulatory Surgical Center (ASC) Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40.
Partial Hospitalization See details
Primewell Classic (HMO-POS) covers partial hospitalization with a $60 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Primewell Classic (HMO-POS) plan. Medicare-covered ground ambulance services have a $250 copay, and Medicare-covered air ambulance services have a $260 copay; there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Primewell Classic (HMO-POS) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $40 copay and no coinsurance, and Worldwide Emergency Coverage has a $125 copay and no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Primewell Classic (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $40 copay for individual and group sessions, other health care professional services with a 20% coinsurance and a copay between $0 and $35, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Primewell Classic (HMO-POS) plan covers preventive services, including annual physical exams, kidney disease education services, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan also covers home-based palliative care and fitness benefits. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services are covered by the Primewell Classic (HMO-POS) plan, including hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but inner ear, outer ear, and over the ear prescription hearing aids are not covered; OTC hearing aids are covered with no copay.
Vision Services See details
The Primewell Classic (HMO-POS) plan covers vision services, including eye exams with a $35 copay, and eyewear with no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are all covered with no copay. Contact lenses are limited to 12 pairs per year, and eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are limited to 1 per year. The plan offers a combined maximum benefit of $400 per year for all eyewear.
Dental Services See details
Dental Services are covered under the Primewell Classic (HMO-POS) plan, with no copay for Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Fluoride Treatment. Other Dental Services include a $2,200 annual maximum. Orthodontic Services are covered under Diagnostic and Preventive Dental, and Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Implant Services, Prosthodontics (fixed), and Oral and Maxillofacial Surgery are covered with no copay. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Primewell Classic (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Primewell Classic (HMO-POS) plan, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. For Durable Medical Equipment, you will pay 20% coinsurance with no copay, and for Prosthetic Devices and Medicare-covered Medical Supplies, you will pay 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Primewell Classic (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a coinsurance up to 20%.
Home Health Services See details
Home Health Services are covered by the Primewell Classic (HMO-POS) plan, with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Primewell Classic (HMO-POS) plan, but the plan does not specify the cost sharing information, so the cost is unknown. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
The Primewell Classic (HMO-POS) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, there is no copay, but for days 21-100, there is a $165 copay.
Other Services See details
Other Services for Primewell Classic (HMO-POS) includes coverage for Over-the-Counter (OTC) Items, but acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered. Additionally, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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