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The Health Plan SecureCare Integrity Plan 1 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for The Health Plan SecureCare Integrity Plan 1 (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 Integrity Plan 1 (HMO) in 2025, please refer to our full plan details page.
The Health Plan SecureCare Integrity Plan 1 (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 Integrity Plan 1 (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about The Health Plan SecureCare Integrity Plan 1 (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 Integrity Plan 1 (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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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:
Sign up for The Health Plan SecureCare Integrity Plan 1 (HMO)
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Drug Coverage
Prescription drugs are not covered by The Health Plan SecureCare Integrity Plan 1 (HMO).
Additional Benefits
The Health Plan SecureCare Integrity Plan 1 (HMO) offers comprehensive coverage with a variety of benefits. The plan covers inpatient hospital stays with a copay, outpatient services with varying copays, and ambulance services. Additionally, the plan includes coverage for primary care, preventive services, hearing, vision, dental, and home health services. This plan also provides benefits such as coverage for home infusion bundled services, dialysis services, medical equipment, diagnostic and radiological services, and skilled nursing facilities. It also offers additional benefits, including over-the-counter items with a quarterly allowance, and a meal benefit. However, some services like routine chiropractic care, non-emergency worldwide urgent coverage, and certain types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you pay a $295 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. Inpatient Hospital Psychiatric services have a $295 copay for days 1-6, and no copay for days 7-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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 $250, Observation Services have a $200 copay, Ambulatory Surgical Center Services have a $250 copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay of $35, and Outpatient Blood Services have a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered with a copay, including a $250 copay for ground ambulance services and a $500 copay for air ambulance services. Transportation services to any health-related location are covered for up to 35 round trips per year, with a maximum plan benefit coverage amount of $1000.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $110, $40, and $110, respectively, with no coinsurance. Worldwide Urgent Coverage is not covered, and Worldwide Emergency Transportation has a copay between $250 and $500, with no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $25,000.
Primary Care See details
The Health Plan SecureCare Integrity Plan 1 (HMO) covers Primary Care Physician Services, Occupational Therapy Services (with a $40 copay), Physician Specialist Services (with a $35 copay), Mental Health Specialty Services, Podiatry Services (with a $35 copay), Other Health Care Professional services (with a $35 copay), Psychiatric Services, Physical Therapy and Speech-Language Pathology Services (with a $40 copay), Additional Telehealth Benefits, and Opioid Treatment Program Services (with a $35 copay). Chiropractic Services are covered with a $20 copay, but Routine Chiropractic Care is not covered.
Preventive Services See details
The Health Plan SecureCare Integrity Plan 1 (HMO) covers preventive services, including Medicare-covered preventive services with prior authorization, annual physical exams, additional preventive services, health education, personal emergency response systems, additional sessions of smoking and tobacco cessation counseling (up to 8 visits), fitness benefits, kidney disease education services, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. In-home safety assessments, medical nutrition therapy, 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 are not covered.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and over-the-counter hearing aids. Hearing exams have a $35 copay, and routine hearing exams are limited to one per year, while Fitting/Evaluation for Hearing Aids are unlimited. Prescription hearing aids (all types) have a copay between $599 and $899 every two years, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Health Plan SecureCare Integrity Plan 1 (HMO) covers routine eye exams, with one exam allowed per year, and eyewear, with a combined maximum of $200 per year. Contact lenses are covered, with the number of pairs varying based on annual use, and eyeglass lenses and frames are covered, with one pair allowed per year; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Health Plan SecureCare Integrity Plan 1 (HMO) covers Medicare Dental Services with a $35 copay, and other dental services including oral exams, dental x-rays, and cleaning. The plan also covers orthodontic services with a maximum benefit of $1500 per year, and restorative services, endodontics, periodontics, prosthodontics (removable and fixed), 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. 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 by The Health Plan SecureCare Integrity Plan 1 (HMO). You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a coinsurance between 0-20%, and Diabetic Therapeutic Shoes/Inserts have 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 copay up to $150. Therapeutic Radiological Services have a 20% coinsurance, while Outpatient X-Ray Services have a $50 copay, and Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by The Health Plan SecureCare Integrity Plan 1 (HMO) 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 technically covered, 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 for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under The Health Plan SecureCare Integrity Plan 1 (HMO) with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Health Plan SecureCare Integrity Plan 1 (HMO) covers Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $120.00 every three months, and a Meal Benefit requiring 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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