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Wellpoint Extra Help (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Extra Help (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Extra Help (HMO-POS) in 2026, please refer to our full plan details page.
Wellpoint Extra Help (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Tennessee. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellpoint Extra Help (HMO-POS) 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 Wellpoint Extra Help (HMO-POS).
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 Wellpoint Extra Help (HMO-POS), 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 $390.00 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 $9000.00 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 Wellpoint Extra Help (HMO-POS) prescription drug plan features an annual drug deductible of $390. Members enjoy no copay for Tier 1 Preferred Generic and Tier 6 Select Care Drugs when using standard pharmacies or standard mail order. For other tiers, a 25% coinsurance applies to Tier 2 Generic, Tier 3 Preferred Brand, and Tier 4 Non-Preferred Drugs. Tier 5 Specialty Tier drugs require a 28% coinsurance for a 1-month supply at standard pharmacies or through standard mail order.
Additional Benefits
The Wellpoint Extra Help (HMO-POS) plan offers robust healthcare coverage with no copay or coinsurance for primary care, telehealth, and preventive visits. Specialist visits require a $25 copay, while emergency room services have a $115 copay. For inpatient hospital stays, members pay a $345 copay for the first several days and no copay for additional days. Supplemental benefits include preventive dental care with no copay, alongside comprehensive dental coverage up to a $3,000 annual limit with a 25% coinsurance. Routine vision and hearing exams feature no copay, and the plan provides up to $250 for eyewear and up to $3,000 for prescription hearing aids. Members also enjoy no copay for up to 96 one-way transportation trips and a $60 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellpoint Extra Help (HMO-POS) with no coinsurance, requiring a $345 copay for days 1-7 of acute stays and days 1-6 of psychiatric stays, followed by no copay for additional days. Non-Medicare-covered stays and upgrades are not covered, and prior authorization is required.
Outpatient Services See details
Wellpoint Extra Help (HMO-POS) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $25 copay for substance abuse sessions. Outpatient hospital and observation services require prior authorization and have copays ranging from $0 to $345 per stay.
Partial Hospitalization See details
Wellpoint Extra Help (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellpoint Extra Help (HMO-POS) covers ground and air ambulance services with a $325 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 96 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Wellpoint Extra Help (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered with a $115 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Wellpoint Extra Help (HMO-POS) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical, occupational, speech, mental health, psychiatric, and opioid therapies require a $25 copay and no coinsurance. Podiatry and other professional services have copays ranging from $0 to $25 with no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Wellpoint Extra Help (HMO-POS) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, and glaucoma screenings. However, several supplemental options are not covered, including the fitness benefit, health education, nutritional or dietary benefits, and in-home safety assessments.
Hearing Services See details
Wellpoint Extra Help (HMO-POS) covers annual routine hearing exams and fitting evaluations with no copay or coinsurance, though Medicare-covered exams require a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually (excluding inner ear, outer ear, and over the ear types), while over-the-counter hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Wellpoint Extra Help (HMO-POS) offers vision services with no deductible and no coinsurance, featuring no copay for one routine eye exam per year and no copay for eyewear up to a $250 annual limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Wellpoint Extra Help (HMO-POS) features partially covered dental services with an annual maximum benefit of $3,000, offering preventive care with no copay and no coinsurance. Comprehensive services are covered with no copay and a 25% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellpoint Extra Help (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellpoint Extra Help (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Extra Help (HMO-POS) covers durable medical equipment with no copay and a coinsurance of 0% to 20%. Prosthetic devices and medical supplies are covered with no copay and a 20% coinsurance, while diabetic equipment and supplies feature no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Extra Help (HMO-POS) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $90 copay for diagnostic tests. Radiological services require prior authorization and include a $50 copay for outpatient X-rays, a minimum $50 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Wellpoint Extra Help (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellpoint Extra Help (HMO-POS) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Wellpoint Extra Help (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day inpatient hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the standard Medicare-covered limit.
Other Services See details
Wellpoint Extra Help (HMO-POS) provides partially covered Other Services with no copay and no coinsurance, featuring a chronic illness meal benefit, Medicare Community Resource Support, and up to $60 every three months for over-the-counter items. Acupuncture is not covered under this benefit.
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