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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 $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 Wellpoint Medicare Advantage 2 (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies, $10 at standard pharmacies, and no copay for standard mail order. Standard generic drugs have 20% coinsurance, while preferred brand drugs have 35% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while many outpatient services, including primary care, preventive services, and dental services, have no copay. The plan also covers hearing, vision, and dental services, along with home health and skilled nursing facility care, all with either a $0 copay or a low copay. Additional benefits include coverage for ambulance and transportation services, emergency services, and various therapies, each with specific copays. The plan also covers home infusion services and dialysis services, with coinsurance applying to some services. Medical equipment, diagnostic services, and radiological services have varying cost-sharing structures, including copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. 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; Non-Medicare-covered Stay and Upgrades are not covered.
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, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers partial hospitalization services with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services, each with a $295 copay, and transportation services to plan-approved health-related locations with no copay, up to 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $30 copay, and there is no coinsurance for any of these services.
Primary Care See details
Wellpoint Medicare Advantage 2 (HMO-POS) 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, and mental health specialty services with a $25 copay for individual and group sessions. This plan also includes podiatry services with a copay between $0 and $25, other health care professional services with a copay between $0 and $20, psychiatric services with a $25 copay for individual and group sessions, 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.
Preventive Services See details
Preventive Services, including Medicare-covered services, have no copay. Annual physical exams also have no copay. The plan does not cover 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 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, and telemonitoring services. Personal Emergency Response System (PERS), Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers hearing exams with a $25 copay and covers routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $3,000 per year, and OTC hearing aids are covered with no copay up to $300 per year. Prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$25, and eyewear with no copay. Routine eye exams have a copay of $0 for 1 visit per year. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers dental services, including oral exams, X-rays, and other diagnostic and preventative services, with no copay. Restorative services, endodontics, periodontics, and other services also have no copay. Other dental services have a maximum benefit of $2,500 per year.
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 and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits under the Wellpoint Medicare Advantage 2 (HMO-POS) plan include Durable Medical Equipment (DME) with 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay between $0 and $150, lab services with no copay, and all radiological services. Diagnostic Radiological Services have a copay between $50 and $350, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by 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
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, or Additional Cardiac Rehabilitation 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
Other services include coverage for over-the-counter items, meal benefits, and other services 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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