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Primewell Giveback (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Primewell Giveback (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Primewell Giveback (HMO-POS) in 2025, please refer to our full plan details page.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Primewell Giveback (HMO-POS) is a HMO-POS plan offered by Louisiana Health Service & Indemnity Company available for the 2025 plan year 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 Giveback (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 Giveback (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 Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $60.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
Health deductible: information not available.
This plan has a $195.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5400.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5400.00 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:
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Drug Coverage
The Primewell Giveback (HMO-POS) plan has a $195 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance for your medications depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay a $12 copay at a preferred pharmacy, and $18 at a standard pharmacy. For preferred brand drugs, you will pay 50% coinsurance, regardless of the pharmacy. During the catastrophic coverage phase, you pay nothing for Part D covered drugs.
Additional Benefits
The Primewell Giveback (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, but many outpatient services, including primary care and hearing exams, have no copay. Dental, vision, and hearing services are covered, with dental having a yearly maximum benefit. Other key benefits include coverage for ambulance services, emergency services, and home health services, though some services may have copays or coinsurance. The plan also covers diagnostic and radiological services, as well as skilled nursing facility stays with a copay after the initial 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered by the Primewell Giveback (HMO-POS) plan. For days 1-7, there is a $295 copay, and days 8-90 have no copay.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, are covered with a copay between $0 and $350, and Observation Services are covered with a $295 copay. Ambulatory Surgical Center (ASC) Services have no copay, while Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $40. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Primewell Giveback (HMO-POS) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Primewell Giveback (HMO-POS) plan. Ground ambulance services have a $250 copay, while air ambulance services have a $300 copay, and there is no coinsurance for either. 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 by the Primewell Giveback (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $50 copay; all three have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Primewell Giveback (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay (routine care not covered), Occupational Therapy Services with a $35 copay, and Physician Specialist Services with a $35 copay. The plan also covers Mental Health Specialty Services with a $40 copay for individual and group sessions, Other Health Care Professional services with a $0-$35 copay and 20% coinsurance, and Psychiatric Services with a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services are covered with a $35 copay, Additional Telehealth Benefits have a $0-$40 copay, and Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
The Primewell Giveback (HMO-POS) plan covers preventive services, including Medicare-covered services, annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Some services, such as health education, in-home safety assessments, and others, are not covered.
Hearing Services See details
The Primewell Giveback (HMO-POS) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit of $800 per year, and OTC hearing aids are covered with no copay. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Primewell Giveback (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 also have no copay.
Dental Services See details
The Primewell Giveback (HMO-POS) plan covers dental services, with a $2,200 maximum benefit per year, and includes no copay for Medicare Dental Services, Oral Exams (up to 2 per year), Dental X-Rays (1 per year), Other Diagnostic Dental Services (1 per year), Prophylaxis (Cleaning) (2 per year), Fluoride Treatment (2 per year), Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Implant Services, Prosthodontics (fixed), and Oral and Maxillofacial Surgery. 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, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay, and 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 by the Primewell Giveback (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics/medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a 20% coinsurance, and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes/inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Primewell Giveback (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $30, and Lab Services have no copay; Diagnostic Radiological Services have a copay up to $200.00. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the Primewell Giveback (HMO-POS) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Primewell Giveback (HMO-POS) plan, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Primewell Giveback (HMO-POS) plan, with a prior authorization requirement. There is no copay for days 1-20, but there is a $200 copay for days 21-100. Additional days beyond Medicare coverage and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, but does not cover Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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. The plan does not have a maximum plan benefit coverage amount for OTC items and does not offer Nicotine Replacement Therapy (NRT) or Naloxone coverage as a Part C OTC benefit, nor does it cover all drugs on the CMS OTC list.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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