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Wellpoint Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Medicare Advantage (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Medicare Advantage (HMO-POS) in 2025, please refer to our full plan details page.
Wellpoint Medicare Advantage (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 Medicare Advantage (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 Medicare Advantage (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 Medicare Advantage (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Medicare Advantage (HMO-POS) plan has an enhanced alternative drug benefit. This plan has no deductible. In the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy, and a $10 copay at a standard pharmacy. For standard generic drugs and preferred brand drugs, you'll pay 20% and 35% coinsurance, respectively. Non-preferred drugs have a 33% coinsurance. Specialty tier drugs have no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellpoint Medicare Advantage (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services and emergency services have copays as well. The plan also covers primary care with no copay, and offers additional benefits like hearing, vision, and dental services, often with no copay or a small copay.
Inpatient Hospital See details
Inpatient hospital services are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $45 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Medicare Advantage (HMO-POS) plan with prior authorization, and has a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan. Ground and air ambulance services have a $295 copay, and transportation services to a plan-approved health-related location have no copay for up to 60 one-way trips per year via rideshare, bus/subway, van, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $30 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $125 copay.
Primary Care See details
The Wellpoint Medicare Advantage (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, physician specialist services with a $45 copay, mental health specialty services with a $45 copay for individual and group sessions, podiatry services with a copay between $0 and $45, other health care professional services with a copay between $0 and $20, psychiatric services with a $45 copay for individual and group sessions, physical therapy and speech-language pathology services with a $45 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $45 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services with a copay as described in the plan documents. Additional services covered include Personal Emergency Response System (PERS) with no copay, and Fitness Benefit with no copay. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 Benefit, 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. Home and Bathroom Safety Devices and Modifications have a maximum plan benefit of $500 every year.
Hearing Services See details
The Wellpoint Medicare Advantage (HMO-POS) plan covers hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $3000 per year, with no copay for all types of prescription hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with no copay, up to a maximum of $300 per year.
Vision Services See details
The Wellpoint Medicare Advantage (HMO-POS) plan covers vision services including eye exams with a copay between $0 and $45, and eyewear such as contact lenses, eyeglasses, and eyeglass frames with no copay and a combined maximum plan benefit of $200 every year. Routine eye exams have no copay and are covered once a year.
Dental Services See details
Dental services are covered under the Wellpoint Medicare Advantage (HMO-POS) plan, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Restorative services, endodontics, periodontics, prosthodontics, and oral surgery are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, the copay is $35. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment includes Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, and Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $150, Lab Services have no copay, Diagnostic Radiological Services have a copay between $50 and $350, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and the copay information can be found below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellpoint Medicare Advantage (HMO-POS) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $60 every three months. Meal benefits and other services are covered with no copay. Acupuncture, Dual Eligible SNPs, 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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