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Wellpoint Medicare Advantage 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Medicare Advantage 2 (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 2 (HMO-POS) in 2025, please refer to our full plan details page.
Wellpoint Medicare Advantage 2 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties 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 2 (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 2 (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 2 (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 Maximum Out-Of-Pocket cost of $4150.00 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 Medicare Advantage 2 (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different amounts depending on the drug tier and the pharmacy you use. For example, you will pay a $5 copay for preferred generic drugs at a preferred pharmacy, and 20% coinsurance for standard generic drugs at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $350 copay for days 1-6, but no copay for the rest of the stay. Outpatient services, including primary care, specialist visits, and mental health services, typically have a $0-$30 copay. This plan also includes coverage for ambulance services with a $295 copay, and emergency services with a $140 copay. Hearing and vision services are included, with no copays for routine eye exams, eyewear, and some hearing services. Dental services are covered with no copay and a $2,500 annual maximum benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $350 for days 1-6 and no copay for days 7-90. Additional days for both Inpatient Hospital-Acute and Psychiatric are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $30 copay for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers partial hospitalization with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. Ground and air ambulance services have a copay of $295.00, and transportation services to a plan-approved health-related location have no copay, with a limit of 60 one-way trips per year. 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 2 (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay, and Urgently Needed Services have a $30 copay; all of these services have no coinsurance.
Primary Care See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $30 copay, and physician specialist services have a $30 copay. Mental health specialty services and psychiatric services have a $30 copay for individual and group sessions. Podiatry services have a copay between $0 and $30. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have no copay. Other Health Care Professional services have a copay between $0 and $20, and Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services and kidney disease education services are covered, but the copay information is available elsewhere. Other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following the Welcome Visit, are covered with no copay. 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 include hearing exams with a $30 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay and a maximum benefit of $300 per year for both ears combined. Prescription hearing aids are covered with a maximum benefit of $3,000 per year for both ears combined, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$30, and eyewear with no copay; contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay, with a combined maximum of $250 per year for eyewear. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are unlimited.
Dental Services See details
Dental services are covered, with a $2,500 annual maximum benefit. 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 are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. Durable Medical Equipment (DME) has no copay with a coinsurance of 0-20%, and Prosthetics/Medical Supplies have no copay with 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests have a minimum copay of $0 and a maximum copay of $150, while lab services have no copay. Diagnostic radiological services have a copay between $50 and $350, and therapeutic radiological services have a coinsurance of at least 20%. Outpatient X-ray services have a $50 copay.
Home Health Services See details
Home Health Services are covered under the Wellpoint Medicare Advantage 2 (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
Wellpoint Medicare Advantage 2 (HMO-POS) does not cover Cardiac Rehabilitation Services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellpoint Medicare Advantage 2 (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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