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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 Southeastern OH, West Virginia. 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 $6700.00 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:
Sign up for The Health Plan SecureCare - Option II (HMO)
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Drug Coverage
The Health Plan SecureCare - Option II (HMO) features an annual prescription drug deductible of $395. For Tier 1 preferred generic drugs, members enjoy no copay when using preferred pharmacies or preferred mail order services, compared to a $13 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs are also highly affordable, costing just a $4 copay for a one-month supply at preferred pharmacies and preferred mail order. Higher-tier medications are covered through coinsurance rather than flat copayments. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance at both preferred and standard pharmacies. Specialty drugs in Tier 5 require a 28% coinsurance for a one-month supply regardless of the pharmacy network chosen.
Additional Benefits
The Health Plan SecureCare - Option II (HMO) offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care and telehealth visits. Specialist visits and Medicare-covered dental services require a $45 copay, while emergency care carries a $130 copay that is waived if you are admitted to the hospital within twenty-four hours. For inpatient hospital stays, the plan requires a $325 daily copay for the first six days and no copay for days seven through ninety. This plan also includes valuable supplemental benefits, such as no copay for routine vision exams and preventive dental care, alongside a $55 quarterly over-the-counter allowance. While skilled nursing facility stays feature no copay for the first twenty days, durable medical equipment and dialysis services require a twenty percent coinsurance. Routine hearing exams are available with a $20 copay, and prescription hearing aids are covered with copays ranging from $399 to $899.
Inpatient Hospital See details
The Health Plan SecureCare - Option II (HMO) covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered at no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by The Health Plan SecureCare - Option II (HMO) with no coinsurance for all services, featuring copays of $0 to $500 for outpatient hospital care, $500 for ambulatory surgical center visits, and $45 for substance abuse sessions. Outpatient blood services are fully covered with no copay or deductible, though prior authorization is required for most other outpatient treatments.
Partial Hospitalization See details
The Health Plan SecureCare - Option II (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
The Health Plan SecureCare - Option II (HMO) covers ground ambulance services with a $250 copay and air ambulance services with a $500 copay, both featuring no coinsurance and requiring prior authorization. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
The Health Plan SecureCare - Option II (HMO) covers emergency services with a $130 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $25,000 maximum benefit with no coinsurance, which includes emergency care for a $130 copay and emergency transportation for a $250 to $500 copay, while worldwide urgent coverage is not covered.
Primary Care See details
The Health Plan SecureCare - Option II (HMO) offers primary care and telehealth services with no copay and no coinsurance, while physical and occupational therapy are covered with a $40 copay and no coinsurance. Specialist visits, mental health, psychiatric, podiatry, and opioid treatment services require a $45 copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive Services under The Health Plan SecureCare - Option II (HMO) are partially covered with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, and glaucoma screenings. While select programs like memory fitness and personal emergency response systems are included, several additional services such as in-home safety assessments, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by The Health Plan SecureCare - Option II (HMO), featuring a $20 copay and no coinsurance for annual routine exams with no deductible. Prescription hearing aids are covered with no coinsurance and copays ranging from $399 to $899, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
The Health Plan SecureCare - Option II (HMO) provides partially covered vision services with no copay and no coinsurance for routine eye exams and eyewear, up to a $200 annual limit. Other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered under this plan.
Dental Services See details
Dental services are partially covered by The Health Plan SecureCare - Option II (HMO), featuring a $45 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive exams, cleanings, and x-rays. Comprehensive services like restorative care, endodontics, periodontics, prosthodontics, and oral surgery have no copay and 0% to 50% coinsurance up to a $1,000 annual limit, while fluoride, implants, orthodontics, adjunctive general, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
The Health Plan SecureCare - Option II (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay with no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs require a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by The Health Plan SecureCare - Option II (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by The Health Plan SecureCare - Option II (HMO) with no copay and a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and diabetic services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by The Health Plan SecureCare - Option II (HMO), as laboratory services are not covered and prior authorization is required. Covered diagnostic procedures and outpatient X-rays require a $50 copay, while diagnostic radiological services have no copay, and therapeutic radiological services require 20% coinsurance with no coinsurance on diagnostic services.
Home Health Services See details
The Health Plan SecureCare - Option II (HMO) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by The Health Plan SecureCare - Option II (HMO) with no copay and no coinsurance. While some services are covered, 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, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services under The Health Plan SecureCare - Option II (HMO) are partially covered with no copay and no coinsurance, offering benefits like chronic illness meals and a $55 quarterly over-the-counter (OTC) allowance. Acupuncture, nicotine replacement therapy, and certain standard OTC drugs are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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