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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 $4900.00 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. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies and a $0 copay through standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have a copay that varies by service. Emergency, primary care, and preventive services, like annual physical exams, have no copay. This plan provides coverage for hearing, vision, and dental services, including exams, eyewear, and hearing aids, often with no copay. The plan also covers ambulance, transportation, and home health services. Diagnostic and radiological services, along with skilled nursing facilities, have copays or coinsurance, while medical equipment and home infusion services have varying costs depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric services. For inpatient hospital acute and psychiatric, you will pay a $350 copay for days 1-6, and no copay for days 7-90. Additional days for both acute and psychiatric services are covered with no copay. Non-Medicare-covered stays and upgrades for acute and psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan, including outpatient hospital services with a copay ranging from $0 to $350, observation services with a $350 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $35 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $295 copay, and transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Wellpoint Medicare Advantage 2 (HMO-POS), with a $125 copay and no coinsurance. Urgently Needed Services have a $30 copay and no coinsurance, and Worldwide Emergency Services have a $125 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and mental health specialty services with a $35 copay for individual and group sessions. The plan also covers podiatry services, other health care professional services with a copay between $0 and $20, psychiatric services with a $35 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $35 copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services with a copay. Additional services that are not covered include 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, and telemonitoring services. The plan also covers Personal Emergency Response Systems, Fitness Benefits, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, and Other Preventive Services, all with no copay.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $3,000 per year with no copay for all types of hearing aids except for inner ear, outer ear, and over the ear hearing aids which are not covered. OTC hearing aids are covered with no copay up to $300 per year.
Vision Services See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $300 per year. Routine eye exams have no copay, with one exam allowed per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services, 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, all with no copay. There is a $2,500 annual maximum for Other Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment coverage under the Wellpoint Medicare Advantage 2 (HMO-POS) plan includes Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered, including diagnostic procedures/tests with a copay between $0 and $150, lab services with no copay, and outpatient X-ray services with a $50 copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and diagnostic radiological services have a copay of at most $350.
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 any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays 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, 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, 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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