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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 Southeastern OH, 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 - 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 $5900.00 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 no deductible. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you pay no copay at a preferred pharmacy or preferred mail, and a $20 copay at a standard pharmacy or standard mail. For other drugs, you pay coinsurance between 20% and 40% depending on the drug tier. 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 comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays, outpatient services, primary care, and specialist visits with varying copays. It also provides coverage for ambulance and transportation services, emergency services, hearing and vision care, and dental services. Additional benefits include preventive services, home health services, and services such as home infusion, dialysis, and medical equipment. The plan also covers some over-the-counter items and a meal benefit for chronic illnesses. However, it's important to note that some services, like certain hearing aids, eyewear upgrades, and specific dental and vision procedures, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $325 for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and Upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $500, observation services have a $500 copay, and ambulatory surgical center services have a $500 copay. Individual and group outpatient substance abuse sessions have a copay of $45, and outpatient blood services have a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $250 copay, while air ambulance services have a $500 copay. Transportation Services to any health-related location are covered for up to 18 round trips per year, with a maximum plan benefit coverage amount of $500.
Emergency Services See details
Emergency Services, including urgently needed services, are covered by The Health Plan SecureCare - Option II (HMO). Emergency Services have a $125 copay with no coinsurance, while urgently needed services have a $40 copay with no coinsurance. Worldwide Emergency Coverage has a $125 copay, and Worldwide Emergency Transportation has a copay between $250 and $500. Worldwide Urgent Coverage is not covered.
Primary Care See details
Primary Care Physician Services have a $5 copay. Chiropractic Services are covered with 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 have a $45 copay for individual and group sessions. Podiatry Services have a $45 copay for Medicare-covered services and routine foot care. Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services each have a $45 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits are available for some services.
Preventive Services See details
The Health Plan SecureCare - Option II (HMO) covers several preventive services, including Medicare-covered preventive services with prior authorization. This plan also covers annual physical exams, health education, Personal Emergency Response System (PERS), Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit (Memory Fitness), Kidney Disease Education Services, and other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, 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 Benefit, 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 exams are covered with a $45 copay, and routine hearing exams are covered once per year. Prescription hearing aids are covered with a copay between $599 and $899 every two years for all types of hearing aids, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with one visit covered every year, and eyewear benefits. Eyewear includes a combined maximum plan benefit of $200 per year for contact lenses, eyeglass lenses (1 pair per year), and eyeglass frames (1 pair per 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, Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Restorative Services with 0%-50% coinsurance, Endodontics with 0%-50% coinsurance, Periodontics with 0%-50% coinsurance, Prosthodontics (removable) with 0%-50% coinsurance, Prosthodontics (fixed) with 0%-50% coinsurance, and Oral and Maxillofacial Surgery with 0%-50% coinsurance. 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under The Health Plan SecureCare - Option II (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Medical Supplies have a 20% coinsurance, and Diabetic Supplies have between 0% and 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Health Plan SecureCare - Option II (HMO) covers diagnostic and radiological services, but lab services are not covered. Diagnostic Procedures/Tests have a $50 copay, while Diagnostic Radiological Services have a maximum copay of $150, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by The Health Plan SecureCare - Option II (HMO), with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
The Health Plan SecureCare - Option II (HMO) plan covers Cardiac Rehabilitation Services, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by The Health Plan SecureCare - Option II (HMO) with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100, and additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) and Non-Medicare-covered stays are not covered.
Other Services See details
The Health Plan SecureCare - Option II (HMO) offers Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months, while 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. The plan also covers a meal benefit for chronic illnesses, but prior authorization is required.
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