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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 $6445.00 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. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at preferred, standard, and standard mail-order pharmacies. For Tier 2 generic drugs, there is also no copay at preferred pharmacies and standard mail-order services, while standard pharmacies charge a copay ranging from $10 to $30 depending on the supply. For higher-tier medications, costs are structured around coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs incur a 30% coinsurance across standard and preferred pharmacies. Specialty drugs are limited to a one-month supply under these cost-sharing terms.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers robust healthcare coverage featuring no copays or coinsurance for primary care visits, annual physicals, and home health services. For specialized medical needs, members can expect a $35 copay for specialist visits and a $130 copay for emergency room care. Inpatient hospital stays require a $350 daily copay for the first six days, with no copay required for day seven and beyond. Additionally, the plan provides valuable supplemental benefits including dental, vision, and hearing coverage with no copays for preventive dental care, routine eye exams, and routine hearing tests. Members also benefit from no copays on prescription hearing aids up to a $3,000 annual limit, eyewear up to $300 yearly, and a $30 quarterly allowance for over-the-counter items. Essential diabetic equipment and supplies are also fully covered with no copays or coinsurance.
Inpatient Hospital See details
Wellpoint Medicare Advantage 2 (HMO-POS) partially 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. Non-Medicare-covered stays and upgrades are not covered, and prior authorization is required.
Outpatient Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $350, observation services carry a $350 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with a $40.00 copay and no coinsurance. Prior authorization is required for these covered services.
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, requiring prior authorization. Although some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is 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, with no coinsurance required for either. Worldwide emergency, urgent, and 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) provides primary care and telehealth services with no copay and no coinsurance, though chiropractic services are not covered in practice. Specialist visits, mental health, psychiatric, occupational, physical, speech, and opioid therapy services require a $35 copay and no coinsurance. Other professional services range from a $0 to $15 copay, and podiatry services range from no copay to a $35 copay, both with no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and glaucoma screenings. Supplemental services such as fitness benefits, health education, in-home safety assessments, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, telemonitoring, counseling, and home safety modifications are not covered.
Hearing Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers Medicare-covered hearing exams for a $35 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $3,000 annual limit, though inner ear, outer ear, and over the ear types are not covered. Over-the-counter hearing aids are also covered with no copay and no coinsurance up to a $300 yearly limit.
Vision Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) provides partially covered vision services, featuring no copay and no coinsurance for one routine annual eye exam and eyewear up to a $300 yearly limit. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) dental services are partially covered up to an annual maximum of $2,250, featuring no copay and no coinsurance for preventive care. Covered comprehensive services require no copay and 25% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
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
Wellpoint Medicare Advantage 2 (HMO-POS) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics or medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are fully 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 required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $150 copay for diagnostic procedures, while radiological services require a $90 copay for X-rays, a minimum $50 copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological 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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coverage for additional days beyond the Medicare-covered limit.
Other Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) partially covers other services, offering chronic illness meal benefits, Medicare Community Resource Support, and up to $30 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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