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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 $200.00 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 $6460.00 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 drug deductible of $200. For prescription drugs, Tier 1 preferred generics have no copay at preferred pharmacies, standard pharmacies, and standard mail order. Tier 2 generics also offer no copay at preferred pharmacies and standard mail order, though standard pharmacies charge a copay starting at $10 for a one-month supply. For higher-tier medications, the plan transitions to coinsurance costs instead of flat copays. Tier 3 preferred brand drugs require a 25% coinsurance across preferred, standard, and standard mail-order services. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 30% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, telehealth, and preventive services. For specialized medical care, members pay a copay of up to $45 for specialists, while emergency room visits require a $130 copay. Inpatient hospital stays have a $350 daily copay for the first six days and no copay thereafter, with no coinsurance required. Routine vision, hearing, and preventive dental care are highly accessible with no copays, alongside allowances for eyewear, hearing aids, and a $25 quarterly over-the-counter benefit. Comprehensive dental services are covered with no copay and a 25% coinsurance up to $2,250, while durable medical equipment ranges from no copay to a 20% coinsurance. Skilled nursing facility stays also feature no copay for the first 20 days, ensuring affordable recovery support.
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 because prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services, a $45 copay for outpatient substance abuse sessions, and copays ranging from $0 to $350 for outpatient hospital and observation services. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers ground and air ambulance services with a $325 copay and no coinsurance, with prior authorization required. Transportation services are not covered under this plan.
Emergency Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit, with a $130 copay and no coinsurance per service.
Primary Care See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers primary care physician visits and telehealth benefits with no copay and no coinsurance. Specialist visits, therapies, and mental health services require a copay of up to $45 and no coinsurance, while chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine chiropractic care.
Preventive Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers preventive services, such as annual physical exams, kidney disease education, and diabetes training, with no copay and no coinsurance. Additional preventive services are partially covered with no coinsurance, offering remote access and personal emergency response systems with no copay, while excluding fitness, health education, nutrition therapy, weight management, alternative therapies, and therapeutic massage. Other non-covered services include adult day health, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, telemonitoring, counseling, medication reconciliation, re-admission prevention, wigs, and home safety devices.
Hearing Services See details
Hearing services are covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan, offering Medicare-covered exams for a $45 copay and no coinsurance, alongside routine exams, fittings, and OTC hearing aids (up to $300 annually) for no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 yearly, though 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) with no deductibles or coinsurance, featuring a $0 to $45 copay for eye exams (including no copay for one routine exam yearly) and no copay for eyewear up to a $300 annual limit. Other eye exam services and eyewear upgrades are not covered.
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, and comprehensive services with no copay and 25% coinsurance up to a $2,250 annual limit. 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. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with prior authorization, featuring no coinsurance and no copay for lab services, alongside a $0 to $150 copay for diagnostic procedures. Radiological benefits include a minimum $50 copay for diagnostic services, a minimum 20% coinsurance for therapeutic services, and a $90 copay for outpatient X-rays.
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 covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no coinsurance and require prior authorization. While some services are covered, standard cardiac rehabilitation (with a $35 copay), intensive cardiac rehabilitation ($35 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) partially covers other services with no copay and no coinsurance, including chronic illness meal benefits, Medicare Community Resource Support, and a $25 quarterly over-the-counter item allowance. Acupuncture is not covered under this plan.
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