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The Health Plan SecureCare SNP (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for The Health Plan SecureCare SNP (HMO D-SNP). 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 SNP (HMO D-SNP) in 2025, please refer to our full plan details page.
The Health Plan SecureCare SNP (HMO D-SNP) is a HMO D-SNP plan offered by The Health Plan of West Virginia, Inc. available for enrollment in 2025 to people living in Ohio, West Virginia. 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 SNP (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
The Health Plan SecureCare SNP (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about The Health Plan SecureCare SNP (HMO D-SNP).
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 SNP (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.40. 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 $9350.00 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 SNP (HMO D-SNP) has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs depending on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your premium will be $35.40.
Additional Benefits
The Health Plan SecureCare SNP (HMO D-SNP) offers a range of benefits, including coverage for inpatient and outpatient services, with coinsurance ranging from 20%. The plan also covers primary care, preventive services, hearing, vision, dental, and home infusion services, with varying coinsurance and maximum benefits. Additional benefits include ambulance and transportation services, emergency services, and home health services, with specific cost-sharing structures. The plan provides coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility services. The plan also provides a monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by The Health Plan SecureCare SNP (HMO D-SNP). Additional days, non-Medicare-covered stays, and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by The Health Plan SecureCare SNP (HMO D-SNP), including outpatient hospital services and observation services with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and outpatient substance abuse services are also covered, with a minimum coinsurance of 20% and a maximum coinsurance of 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by The Health Plan SecureCare SNP (HMO D-SNP) with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are covered for up to 25 round trips per year, and other transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by The Health Plan SecureCare SNP (HMO D-SNP). Emergency Services and Urgently Needed Services have a 20% coinsurance, but there is no copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services are covered with a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with prior authorization, annual physical exams, health education, personal emergency response systems, 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 EKG following a Welcome Visit. In-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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 are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20%, fitting/evaluation for hearing aids, and prescription hearing aids with a maximum benefit of $2000 every two years. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Health Plan SecureCare SNP (HMO D-SNP) covers vision services including eye exams and eyewear. Eye exams have a 20% coinsurance, and eyewear has a 20% coinsurance and a combined maximum benefit of $300 per year. Eyeglass frames and lenses are covered, with one pair allowed per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Health Plan SecureCare SNP (HMO D-SNP) covers dental services with a maximum benefit of $3,000 per year. Oral exams, dental x-rays, cleaning, fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. Orthodontics and implant services are not covered, and adjunctive general services and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs. 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 Health Plan SecureCare SNP (HMO D-SNP). You will pay 20% coinsurance for these services.
Medical Equipment See details
The Health Plan SecureCare SNP (HMO D-SNP) covers medical equipment, including durable medical equipment with 20% coinsurance and prosthetics/medical supplies with 20% coinsurance. Diabetic equipment is covered with a coinsurance, and diabetic supplies and therapeutic shoes/inserts have 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by The Health Plan SecureCare SNP (HMO D-SNP) with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by The Health Plan SecureCare SNP (HMO D-SNP). Prior authorization is required for this service.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. The plan requires prior authorization and has coinsurance, but specific coinsurance details are not provided.
Other Services See details
The Health Plan SecureCare SNP (HMO D-SNP) covers Over-the-Counter (OTC) Items with a maximum plan benefit coverage amount of $153.00 every month, but does not cover all drugs on the CMS OTC list. This plan also covers Meal Benefits, but requires prior authorization. Acupuncture, 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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