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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 2025, 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 4.5 out of 5 stars in 2025.
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 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 Capitol Plan (HMO) has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance based on the drug tier and pharmacy type. For example, you will pay no copay for preferred generic drugs at preferred pharmacies. For standard generic drugs, you pay 20% coinsurance regardless of the pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs.
Additional Benefits
The Health Plan SecureCare Capitol Plan (HMO) offers a range of benefits beyond standard Medicare coverage. This plan includes coverage for inpatient and outpatient services, with varying copays depending on the service. Additionally, it provides coverage for ambulance, emergency, and primary care services, as well as preventive, hearing, vision, and dental care. This plan also covers home health services, skilled nursing facilities, and durable medical equipment. It offers additional benefits, such as over-the-counter items and a meal benefit. However, some services, such as certain hearing aids, eyeglasses upgrades, and specific therapies, may not be covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered by The Health Plan SecureCare Capitol Plan (HMO). For Inpatient Hospital-Acute, you will pay a $335 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will also pay a $335 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered; Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, with a copay between $0 and $500, as well as observation services with a $500 copay. Ambulatory Surgical Center (ASC) Services have a $500 copay, and both individual and group sessions for outpatient substance abuse have a $45 copay. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by The Health Plan SecureCare Capitol Plan (HMO), with 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 18 round trips per year, up to a maximum of $500 per year, while transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $125, $40, and $125 respectively, while Worldwide Emergency Transportation has a copay between $250 and $500; all have no coinsurance. Worldwide Urgent Coverage is not covered.
Primary Care See details
The Health Plan SecureCare Capitol Plan (HMO) covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $40 copay. Physician specialist services have a $45 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, and opioid treatment program services have a minimum copay of $45. Physical therapy and speech-language pathology services have a $40 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with prior authorization, annual physical exams, additional preventive services, health education, personal emergency response systems (PERS), additional sessions of smoking and tobacco cessation counseling, fitness benefits, kidney disease education services, glaucoma screening, 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, counseling services, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $45 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899 for two hearing aids every two years, but prescription hearing aids for the inner, outer, or over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear. Eyewear includes a combined maximum of $200 per year, and contact lenses with up to 1 pair covered per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Health Plan SecureCare Capitol Plan (HMO) offers dental services, 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, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while 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 under The Health Plan SecureCare Capitol Plan (HMO), with a coinsurance between 20% and 20%.
Medical Equipment See details
The Health Plan SecureCare Capitol Plan (HMO) covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization. Prosthetics and medical supplies are covered with a 20% coinsurance, while diabetic supplies have a 0-20% coinsurance, and 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
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; however, 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, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
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) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services for The Health Plan SecureCare Capitol Plan (HMO) includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $100 every three months, and a Meal Benefit that requires prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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