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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 2026, 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 2026.
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 a $235.00 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 $6200.00 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:
Sign up for Wellpoint Medicare Advantage 2 (HMO-POS)
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Drug Coverage
The Wellpoint Medicare Advantage 2 (HMO-POS) plan features an annual prescription drug deductible of $235. Under this plan, Tier 1 preferred generic drugs have no copay at preferred, standard, and standard mail-order pharmacies. Tier 2 generic drugs also feature no copay at preferred pharmacies and standard mail-order, while standard pharmacies require a copay ranging from $10 to $30 depending on the supply. Higher-tier medications require coinsurance rather than flat copays during the initial coverage phase. Tier 3 preferred brand drugs incur a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 30% coinsurance. These coinsurance rates apply across preferred, standard, and standard mail-order options, with Tier 5 specialty drugs limited to a one-month supply.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers comprehensive medical coverage featuring no copays for primary care visits, telehealth, home health services, and preventive care. For specialist visits, emergency care, and urgent care, members will pay affordable copays of $35, $130, and $30 respectively, with no coinsurance. Inpatient hospital stays require a $350 daily copay for the first six days and no copay thereafter, while skilled nursing facility stays are covered with no copay for the first 20 days. This plan also includes valuable dental, vision, and hearing benefits, providing no-copay preventive dental care up to $2,250 annually and no-copay routine eye and hearing exams. Additionally, members can access prescription hearing aids up to $2,000 and essential eyewear up to $200 with no copays or coinsurance. Other highlights include no copays for diabetic supplies and a quarterly $25 allowance for over-the-counter items.
Inpatient Hospital See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 6 and no copay for days 7 and beyond. This benefit is partially covered as prior authorization is required, and upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers outpatient hospital services with a copay of $0 to $350 and observation services with a $350 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellpoint Medicare Advantage 2 (HMO-POS) with a $40.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with a $268.00 copay and no coinsurance for both ground and air transportation, though prior authorization is required. Plan-approved and general health-related transportation services are not covered.
Emergency Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency, urgent care, and emergency transportation services are also covered up to a $100,000 maximum limit with a $130 copay and no coinsurance.
Primary Care See details
Wellpoint Medicare Advantage 2 (HMO-POS) offers primary care and telehealth visits with no copay and no coinsurance, while specialist, therapy, mental health, psychiatric, and opioid treatment services require a $35 copay and no coinsurance. Podiatry services range from a $0 to $35 copay with no coinsurance, other healthcare professionals require a $0 to $15 copay with no coinsurance, and some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a personal emergency response system and remote access technologies with no copay and no coinsurance, while sub-services such as fitness benefits, health education, weight management, and nutritional services are not covered.
Hearing Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers hearing services with no deductibles or coinsurance, offering Medicare-covered exams for a $35 copay, and routine annual exams, fittings, and OTC hearing aids (up to $300 yearly) for no copay. Prescription hearing aids are covered up to $2,000 annually with no copay or coinsurance, although inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS), offering one routine eye exam per year and essential eyewear with no copay and no coinsurance up to a $200 annual limit. Other eye exams and eyewear upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS), offering preventive and diagnostic care with no copay and no coinsurance up to a $2,250 annual limit. Comprehensive dental services are available with no copay and a 25% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan with no copay, though prior authorization is required. Within this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellpoint Medicare Advantage 2 (HMO-POS), featuring no copay and 0% to 20% coinsurance for durable medical equipment, and no copay and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $150 copay for diagnostic procedures. Covered radiological services require a $90 copay for X-rays, a minimum $50 copay for diagnostic radiology, and 20% coinsurance for therapeutic radiology, with prior authorization required for all services.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Wellpoint Medicare Advantage 2 (HMO-POS) with no coinsurance and require prior authorization, meaning some services are covered but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan, which does not cover acupuncture but offers several benefits with no copay and no coinsurance. Covered services include Medicare Community Resource Support, chronic illness meal benefits, and up to $25 every three months for over-the-counter (OTC) items.
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