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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 2026, 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 3.5 out of 5 stars in 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $75.00. You must continue to pay paying your reduced 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 $6900.00 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
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 medical coverage featuring no coinsurance for many core services, including inpatient hospital stays which require a daily copay of $345 for days 1 through 6. Primary care doctor visits require a $5 copay, while specialist visits have a $45 copay and telehealth services are available with no copay. Most outpatient services and emergency care are covered with flat copays and no coinsurance, though specialized needs like durable medical equipment and dialysis require a 20% coinsurance. Supplemental benefits include routine vision exams with no copay, no coinsurance, and no deductible, alongside a $200 annual eyewear allowance. Preventive dental care has no copay, while comprehensive dental services are covered up to $1,500 annually with 0% to 50% coinsurance. Additionally, members can access routine hearing exams for a $20 copay and receive a $50 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by The Health Plan SecureCare Integrity Plan 1 (HMO) with no coinsurance, requiring a $345 daily copay for days 1 through 6 of an acute stay (with no copay for additional days) and a $325 daily copay for days 1 through 6 of a psychiatric stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit, and prior authorization is required.
Outpatient Services See details
The Health Plan SecureCare Integrity Plan 1 (HMO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $325 for outpatient hospital services and $300 for ambulatory surgical center visits. Outpatient substance abuse sessions require a $45 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
The Health Plan SecureCare Integrity Plan 1 (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
The Health Plan SecureCare Integrity Plan 1 (HMO) covers Medicare-covered ground ambulance services with a $300 copay and air ambulance services with a $500 copay, both with no coinsurance and requiring prior authorization. While transportation services are technically covered, transport to plan-approved or any health-related locations is not covered in practice.
Emergency Services See details
Emergency services are covered by The Health Plan SecureCare Integrity Plan 1 (HMO) with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted within 24 hours. Worldwide emergency services are partially covered up to a $25,000 limit with no coinsurance, offering a $115 copay for emergency care and a $300 to $500 copay for emergency transportation, while worldwide urgent care is not covered.
Primary Care See details
Primary care benefits under The Health Plan SecureCare Integrity Plan 1 (HMO) include primary care visits for a $5 copay and specialist visits for a $45 copay, both with no coinsurance. Telehealth services feature no copay and no coinsurance, while therapy services require a $35 copay and mental health, podiatry, and opioid treatments cost a $45 copay, all with no coinsurance; chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under The Health Plan SecureCare Integrity Plan 1 (HMO) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and diabetes self-management. While memory fitness and health education are included, several supplemental services, such as in-home safety assessments, medical nutrition therapy, personal emergency response systems, and weight management programs, are not covered.
Hearing Services See details
Hearing services are partially covered under The Health Plan SecureCare Integrity Plan 1 (HMO), offering routine hearing exams for a $20 copay and no coinsurance, and prescription hearing aids for a $399 to $899 copay and no coinsurance. While routine exams are limited to one per year and prescription aids to two every two years, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
The Health Plan SecureCare Integrity Plan 1 (HMO) provides partially covered vision services with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam per year and a $200 annual allowance for contact lenses, eyeglass lenses, and frames, though upgrades and other eye exams are not covered.
Dental Services See details
The Health Plan SecureCare Integrity Plan 1 (HMO) offers partially covered dental services, featuring preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental services for a $45 copay and no coinsurance. Comprehensive benefits such as restorative, endodontic, periodontic, prosthodontic, and oral surgery services are covered up to $1,500 annually with no copay and 0% to 50% coinsurance. Sub-services that are not covered include other diagnostic services, fluoride treatments, other preventive services, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by The Health Plan SecureCare Integrity Plan 1 (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under The Health Plan SecureCare Integrity Plan 1 (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
The Health Plan SecureCare Integrity Plan 1 (HMO) covers durable medical equipment, prosthetics, and diabetic equipment with no copay, subject to prior authorization. A 20% coinsurance applies to most equipment, prosthetics, and diabetic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under The Health Plan SecureCare Integrity Plan 1 (HMO), as lab services are not covered. Diagnostic procedures and outpatient X-rays require a $50 copay and no coinsurance, diagnostic radiological services have no copay and no coinsurance, and therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Home Health Services are covered under The Health Plan SecureCare Integrity Plan 1 (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under The Health Plan SecureCare Integrity Plan 1 (HMO) as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD services, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by The Health Plan SecureCare Integrity Plan 1 (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though the benefit is only partially covered as additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other services are partially covered by The Health Plan SecureCare Integrity Plan 1 (HMO), which features over-the-counter (OTC) items up to $50 every three months and a chronic illness meal benefit, both with no copay and no coinsurance, while acupuncture is not covered.
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