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The Health Plan SecureCare - Option II (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for The Health Plan SecureCare - Option II (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on The Health Plan SecureCare - Option II (HMO) in 2025, please refer to our full plan details page.
The Health Plan SecureCare - Option II (HMO) is a HMO plan offered by The Health Plan of West Virginia, Inc. available for enrollment in 2025 to people living in East Central Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that The Health Plan SecureCare - Option II (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 The Health Plan SecureCare - Option II (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 The Health Plan SecureCare - Option II (HMO), 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:
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Drug Coverage
The Health Plan SecureCare - Option II (HMO) has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a $0 copay for preferred generic drugs at preferred pharmacies and preferred mail order, while standard pharmacies and standard mail order have a $20 copay. The plan also has coinsurance for other drug tiers, including 20% for standard generics, 40% for preferred brands, and 33% for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Health Plan SecureCare - Option II (HMO) offers a range of benefits with varying costs. Inpatient hospital stays have a $325 copay for the first six days, and then no copay for the rest of the stay. Outpatient services have copays depending on the service, while primary care visits have a $5 copay. The plan also includes coverage for hearing, vision, and dental services, with specific copays or coinsurance amounts for each.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered by The Health Plan SecureCare - Option II (HMO). Observation services and ambulatory surgical center services have a $500 copay. Outpatient substance abuse services have a $45 copay for both individual and group sessions. Outpatient blood services are also covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information available about the copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for all ambulance services with no coinsurance, but with a copay for Medicare-covered ground ambulance services at $200.00 and air ambulance services at $500.00. Transportation Services to any health-related location is covered for up to 18 round trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage has a $125 copay, while Worldwide Emergency Transportation has a copay between $200 and $500. Worldwide Urgent Coverage is not covered.
Primary Care See details
The Health Plan SecureCare - Option II (HMO) plan covers primary care physician services with a $5 copay. Chiropractic services have a $20 copay, but routine care is not covered. Occupational therapy services have a $40 copay. Physician specialist services have a $45 copay. Mental health specialty services and psychiatric services have a $45 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay. Podiatry services and other health care professional services have a $45 copay, and opioid treatment program services have a $45 copay.
Preventive Services See details
The Health Plan SecureCare - Option II (HMO) plan covers preventive services, including Medicare-covered services with prior authorization, annual physical exams, health education, personal emergency response systems (PERS), additional sessions of smoking and tobacco cessation counseling (8 visits), fitness benefits (memory fitness), kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. This plan does not cover in-home safety assessments, medical nutrition therapy (MNT), 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, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams are limited to one exam per year. Prescription hearing aids are covered with a copay between $599 and $899 for all types of hearing aids, limited to two aids every two years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Health Plan SecureCare - Option II (HMO) offers vision services including routine eye exams with one visit covered every year, and eyewear with a combined maximum benefit of $200 per year. Contact lenses are covered with a varying number of pairs depending on the annual use, and eyeglass lenses and frames are covered with one pair each year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $45 copay. Other Dental Services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with coinsurance between 0% and 50%. Fluoride treatment, maxillofacial prosthetics, implant services, 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. Other Medicare Part B Drugs have a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by The Health Plan SecureCare - Option II (HMO) with a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by The Health Plan SecureCare - Option II (HMO), with Durable Medical Equipment (DME) subject to 20% coinsurance and Durable Medical Equipment for use outside the home not covered. Prosthetic Devices are covered with 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Equipment is covered, with Diabetic Supplies having a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $50 copay, and Diagnostic Radiological Services with a maximum copay of $150, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $50 copay; however, Lab Services are not covered. All Radiological Services require prior authorization.
Home Health Services See details
Home Health Services are covered under The Health Plan SecureCare - Option II (HMO), with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by The Health Plan SecureCare - Option II (HMO), but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by The Health Plan SecureCare - Option II (HMO), but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100, and there is no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Health Plan SecureCare - Option II (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit coverage amount of $100 every three months. The plan also offers a meal benefit for chronic illnesses, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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