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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 2026, 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 3.5 out of 5 stars in 2026.
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 a $395.00 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 $5000.00 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) prescription drug plan features an annual drug deductible of $395. For Tier 1 preferred generic drugs, members enjoy no copay when using preferred pharmacies or preferred mail-order services. Tier 2 generic drugs are also highly affordable, with copays starting at just $5 for a one-month supply at preferred locations. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance at both standard and preferred pharmacies. Specialty Tier 5 medications are covered with a 28% coinsurance for a one-month supply.
Additional Benefits
The Health Plan SecureCare - Option II (HMO) features comprehensive medical coverage with no copay for primary care visits, telehealth, and preventive services. For specialized care, members pay a $45 copay for specialists, while inpatient hospital stays require a $325 daily copay for the first six days and no copay for days seven through ninety. Emergency care is available with a $130 copay, and urgent care visits have a $40 copay, both of which are waived if you are admitted to the hospital within 24 hours. This plan also includes essential dental, vision, and hearing benefits, featuring no copay for routine vision exams and preventive dental care, alongside a $200 annual allowance for eyewear. Additionally, home health services are available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Members can also take advantage of extra perks like an over-the-counter item allowance of $55 every three months and chronic illness meal benefits with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by The Health Plan SecureCare - Option II (HMO) with no coinsurance, requiring a daily copayment of $325 for days 1 to 6 and no copayment for days 7 to 90 per stay. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under The Health Plan SecureCare - Option II (HMO) are covered with no coinsurance, though prior authorization is required for several benefits. Covered services include outpatient hospital and ambulatory surgical center visits with copays ranging from $0 to $500, outpatient substance abuse sessions at a $45 copay, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial hospitalization is covered by The Health Plan SecureCare - Option II (HMO) with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
The Health Plan SecureCare - Option II (HMO) covers ambulance services with no coinsurance, requiring a $200 copay for ground ambulance and a $500 copay for air ambulance, both of which require prior authorization. For transportation services, only some services are covered, as transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by The Health Plan SecureCare - Option II (HMO) with a $130 copay and no coinsurance, and urgently needed services are covered with a $40 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $25,000 maximum with no coinsurance, offering a $130 copay for emergency care and a $200 to $500 copay for transportation, while worldwide urgent coverage is not covered.
Primary Care See details
The Health Plan SecureCare - Option II (HMO) provides primary care and telehealth services with no copay and no coinsurance, while specialist, mental health, psychiatric, podiatry, and opioid treatment services require a $45 copay and no coinsurance. Physical, occupational, and speech therapy services have a $40 copay and no coinsurance, whereas chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by The Health Plan SecureCare - Option II (HMO) with no copay and no coinsurance for covered services, which include annual physical exams, kidney disease education, and diabetes self-management training. While select benefits like health education and personal emergency response systems are covered, several sub-services such as in-home safety assessments, medical nutrition therapy, weight management programs, and alternative therapies are not covered.
Hearing Services See details
Hearing services are partially covered by The Health Plan SecureCare - Option II (HMO), offering routine hearing exams for a $20 copay and no coinsurance, plus unlimited fitting evaluations. Prescription hearing aids are covered with no coinsurance and copays ranging from $399 to $899 for up to two aids every two years, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
The Health Plan SecureCare - Option II (HMO) provides partially covered vision services with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam per year and eyewear (including contact lenses, eyeglass lenses, and eyeglass frames) up to a $200 annual combined limit, while other eye exam services and upgrades are not covered.
Dental Services See details
Dental services are partially covered by The Health Plan SecureCare - Option II (HMO), with Medicare-covered dental requiring a $45 copay and no coinsurance, preventive services requiring no copay and no coinsurance, and restorative or surgical services requiring no copay and 0% to 50% coinsurance. Other diagnostic services, fluoride, other preventive services, adjunctive general services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
The Health Plan SecureCare - Option II (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs are covered with no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under The Health Plan SecureCare - Option II (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
The Health Plan SecureCare - Option II (HMO) covers medical equipment with no copay, though prior authorization is required. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
The Health Plan SecureCare - Option II (HMO) covers diagnostic and radiological services with prior authorization, though lab services are not covered. Diagnostic procedures require a $50 copay with no coinsurance, diagnostic radiological services have no copay, outpatient X-rays require a $50 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are fully covered under The Health Plan SecureCare - Option II (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
The Health Plan SecureCare - Option II (HMO) offers Cardiac Rehabilitation Services with no copay and no coinsurance, meaning some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
The Health Plan SecureCare - Option II (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by The Health Plan SecureCare - Option II (HMO), featuring over-the-counter (OTC) items up to $55 every three months and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other miscellaneous services are not covered under this benefit.
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