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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 2025, 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 2025.
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 $9.10. 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 $590.00 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 $4900.00 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) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), you will pay $9.10 per month for Part D. During the initial coverage phase, after you pay the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellpoint Extra Help (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll find no copay for primary care visits, many preventive services, and a range of vision and dental services. Additional benefits include hearing aids, ambulance services, and transportation to health-related locations with no copay. The plan also covers home health services and skilled nursing facility stays with no copay for a certain number of days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, which both require prior authorization. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you pay a $325 copay for days 1-6, and no copay for days 7-90. Additional days for both are covered with no copay. Non-Medicare-covered stays and upgrades for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $325, observation services with a $325 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $25 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Extra Help (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $235 copay, and transportation services to plan-approved health-related locations with no copay for up to 96 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Wellpoint Extra Help (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Emergency Transportation have a $125 copay, while Urgently Needed Services have a $35 copay.
Primary Care See details
The Wellpoint Extra Help (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, mental health and psychiatric services with a $25 copay, podiatry services with a copay from $0-$25, other health care professional services with a copay from $0-$20, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $25 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with no copay, annual physical exams with no copay, and additional preventive services with a copay. Other covered preventive services include no copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Health education, 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing Services with the Wellpoint Extra Help (HMO-POS) plan include hearing exams with a $25 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, prescription hearing aids with a maximum benefit of $3,000 per year, and over-the-counter hearing aids with no copay and a maximum benefit of $300 per year. Prescription Hearing Aids - Inner Ear and Prescription Hearing Aids - Outer Ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames, have no copay, but upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay. There is a $3,250 annual maximum benefit for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Extra Help (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and a 0-20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment, which includes Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $90, Lab Services with no copay, Diagnostic Radiological Services with a copay between $50 and $325, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellpoint Extra Help (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellpoint Extra Help (HMO-POS) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Extra Help (HMO-POS) plan. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The Wellpoint Extra Help (HMO-POS) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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