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Wellpoint Extra Help (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Extra Help (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Extra Help (HMO-POS) in 2025, please refer to our full plan details page.
Wellpoint Extra Help (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in New Jersey. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellpoint Extra Help (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 Wellpoint Extra Help (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 Wellpoint Extra Help (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.80. 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 $590.00 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 $7750.00 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:
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Drug Coverage
The Wellpoint Extra Help (HMO-POS) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, with the monthly premium costing $55.80.
Additional Benefits
The Wellpoint Extra Help (HMO-POS) plan offers a variety of benefits, including inpatient and outpatient services, with varying copays. You'll find no copays for primary care visits, preventive services, routine hearing and vision exams, and many dental services. The plan also covers ambulance and transportation services, emergency services, and home health services, all with specific copays or coinsurance. Additional benefits include coverage for hearing aids, eyewear, and medical equipment, along with specific copays or coinsurance amounts. The plan also offers coverage for home infusion, dialysis, and cardiac rehabilitation services. However, some services such as health education, weight management programs, and certain types of therapy are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $335 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $335, and observation services with a $335 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Extra Help (HMO-POS) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Extra Help (HMO-POS) plan. Ground and air ambulance services have a $285 copay, and transportation services to a plan-approved health-related location have no copay and cover up to 32 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Wellpoint Extra Help (HMO-POS) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay. Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are also covered, each with a $110 copay and a maximum plan benefit of $100,000.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services require a $15 copay. Occupational Therapy Services have a $30 copay, and Physician Specialist Services have a $20 copay. Mental Health Specialty Services and Psychiatric Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Additional Telehealth Benefits have no copay.
Preventive Services See details
The Wellpoint Extra Help (HMO-POS) plan covers preventive services including an annual physical exam with no copay, and additional services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit with no copay. The plan also covers a fitness benefit and remote access technologies with no copay, and Personal Emergency Response System (PERS) with no copay. However, health education, in-home safety assessments, 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, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Exams are covered with a $20 copay. Routine Hearing Exams and Fitting/Evaluation for Hearing Aids have no copay. Prescription Hearing Aids are covered, with a maximum benefit of $2000 every year. OTC Hearing Aids are covered with no copay, up to a maximum of $300 every year.
Vision Services See details
Wellpoint Extra Help (HMO-POS) covers vision services including eye exams with a copay between $0 and $20, and eyewear with no copay and a combined maximum benefit of $200 every year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are covered with no copay, while upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with no copay, and other services with a $1,000 maximum benefit per year. Other covered services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 Wellpoint Extra Help (HMO-POS) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%. Prosthetic devices and medical supplies have a 20% coinsurance, while diabetic supplies and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
The Wellpoint Extra Help (HMO-POS) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $100. Lab services have no copay, while diagnostic radiological services have a copay between $45 and $335, and therapeutic radiological services have 20% coinsurance. Outpatient X-ray services have a $45 copay.
Home Health Services See details
Home Health Services are covered by the Wellpoint Extra Help (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Extra Help (HMO-POS) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered, as well as non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services offered by the Wellpoint Extra Help (HMO-POS) plan include Over-the-Counter (OTC) Items and Other 1 with no copay. 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 are not covered.
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