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The Health Plan SecureCare Capitol Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for The Health Plan SecureCare Capitol Plan (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 Capitol Plan (HMO) in 2026, please refer to our full plan details page.
The Health Plan SecureCare Capitol Plan (HMO) is a HMO plan offered by The Health Plan of West Virginia, Inc. available for enrollment in 2025 to people living in Kanawha and Surrounding Counties. 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 Capitol Plan (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 Capitol Plan (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 Capitol Plan (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 $250.00 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 $6500.00 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 Capitol Plan (HMO)
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Drug Coverage
The Health Plan SecureCare Capitol Plan (HMO) features a $250 drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail-order service, while standard options charge a $13 copay for a one-month supply. For Tier 2 generic drugs, the cost is a low $2 copay for a one-month supply at preferred locations, compared to a $20 copay at standard pharmacies and mail-order services. For brand-name and specialty medications, your costs are based on coinsurance rather than flat copayments. You will pay a 20% coinsurance for Tier 3 preferred brand drugs and a 40% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply, with all of these coinsurance rates remaining the same whether you use preferred or standard pharmacies.
Additional Benefits
The Health Plan SecureCare Capitol Plan (HMO) offers affordable coverage for core medical services, featuring no copay for primary care telehealth and a low $5 copay for in-person primary care visits. Specialist visits require a $45 copay, while inpatient hospital stays have a $335 daily copay for days 1 through 6, with no coinsurance required for either service. Emergency care is covered with a $130 copay, which is waived if you are admitted within 24 hours. In addition to medical care, the plan provides robust supplemental benefits including preventive dental and routine vision exams with no copay, plus a $200 annual eyewear allowance. Members also benefit from a $70 quarterly over-the-counter allowance with no copay, and skilled nursing facility stays with no copay for the first 20 days. Comprehensive dental services are covered up to a $1,000 yearly limit with 0% to 50% coinsurance.
Inpatient Hospital See details
The Health Plan SecureCare Capitol Plan (HMO) partially covers inpatient hospital services with no coinsurance and required prior authorization. For acute stays, there is a $335 daily copay for days 1 to 6 and no copay for additional days, while psychiatric stays require a $325 daily copay for days 1 to 6 and no copay for days 7 to 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
The Health Plan SecureCare Capitol Plan (HMO) covers outpatient services with no coinsurance, featuring a $0 to $500 copay for outpatient hospital services, a $500 copay for observation and ambulatory surgical center services, and a $45 copay for outpatient substance abuse sessions. Outpatient blood services are also covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
The Health Plan SecureCare Capitol Plan (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by The Health Plan SecureCare Capitol Plan (HMO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services have a $250 copay and no coinsurance, while air ambulance services have a $500 copay and no coinsurance, with prior authorization required for both.
Emergency Services See details
The Health Plan SecureCare Capitol Plan (HMO) covers emergency services with a $130 copay and urgently needed services with a $40 copay, both featuring no coinsurance and waived if admitted within 24 hours. Worldwide emergency services are partially covered with no coinsurance up to a $25,000 maximum, requiring a $130 copay for emergency care and a $250 to $500 copay for transportation, while worldwide urgent care is not covered.
Primary Care See details
The Health Plan SecureCare Capitol Plan (HMO) covers primary care visits with a $5 copay and no coinsurance, while specialist, mental health, psychiatric, podiatry, and opioid treatment services have a $45 copay and no coinsurance. Physical, occupational, and speech therapies require a $40 copay and no coinsurance, telehealth is available with no copay and no coinsurance, and chiropractic services are not covered.
Preventive Services See details
The Health Plan SecureCare Capitol Plan (HMO) offers partially covered preventive services with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. However, several sub-services are not covered, including in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
The Health Plan SecureCare Capitol Plan (HMO) offers partially covered hearing services, featuring a $20 copay and no coinsurance for annual routine hearing exams, alongside prescription hearing aids costing between $399 and $899 with no coinsurance. 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 Capitol Plan (HMO) partially covers vision services with no copay and no coinsurance, which includes one routine eye exam annually and a $200 yearly allowance for contact lenses, eyeglass lenses, and eyeglass frames. Other eye exam services, upgrades, and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services covered by The Health Plan SecureCare Capitol Plan (HMO) include Medicare-covered dental with a $45 copay and no coinsurance, and preventive care like exams and cleanings for no copay and no coinsurance. Comprehensive dental services are covered up to a $1,000 annual limit with no copay and 0% to 50% coinsurance, though fluoride, implants, orthodontics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
The Health Plan SecureCare Capitol Plan (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by The Health Plan SecureCare Capitol Plan (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
The Health Plan SecureCare Capitol Plan (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under The Health Plan SecureCare Capitol Plan (HMO) and require prior authorization. Outpatient X-rays and diagnostic tests 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, while lab services are not covered.
Home Health Services See details
Home Health Services are covered by The Health Plan SecureCare Capitol Plan (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under The Health Plan SecureCare Capitol Plan (HMO). This includes standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services, none of which are covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by The Health Plan SecureCare Capitol Plan (HMO) with no coinsurance, though prior authorization is required. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no prior three-day inpatient hospital stay required for admission.
Other Services See details
The Health Plan SecureCare Capitol Plan (HMO) offers partial coverage for other services, including a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. While the OTC benefit provides up to $70 every three months, acupuncture and nicotine replacement therapies are not covered.
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