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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 $4150.00 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 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 standard mail orders have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan provides comprehensive coverage, including inpatient hospital stays with a $350 copay for days 1-6 and no copay for days 7-90. It also offers outpatient services with varying copays, ambulance services with a $295 copay, and emergency services with a $140 copay. This plan includes no copay for primary care, preventive services, hearing exams, and vision services. Dental services are also covered with no copay, and there are additional benefits like home health services, skilled nursing facility (SNF) services, and over-the-counter (OTC) items.
Inpatient Hospital See details
Inpatient hospital services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. 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.
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 (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions. Outpatient Blood Services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan. This benefit has a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. Ground and air ambulance services each have a $295 copay, with no coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay and no coinsurance, up to 60 one-way trips per year. Transportation to any health-related location is 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 $140 copay, while Urgently Needed Services have a $30 copay; all have no coinsurance.
Primary Care See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $25 copay. Physician specialist services have a $25 copay, and physical therapy and speech-language pathology services have a $25 copay. Mental health specialty services, podiatry services, other health care professional, psychiatric services, and opioid treatment program services have varying copays. Additional telehealth benefits have no copay.
Preventive Services See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers preventive services, including an annual physical exam with no copay, and other services like Fitness Benefit, Personal Emergency Response System (PERS), Home and Bathroom Safety Devices and Modifications, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) with no copay. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have no copay, and OTC hearing aids have no copay. Prescription hearing aids have a maximum benefit of $3000 per year, and OTC hearing aids have a maximum benefit of $300 per year. Prescription hearing aids - inner ear, Prescription hearing aids - outer ear, and Prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams have no copay for one visit per year, while other eye exams have a copay between $0 and $25. Eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, and a combined maximum benefit of $300 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay. Other dental services, including restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered with no copay. Orthodontic services are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while 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 is covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan, including Durable Medical Equipment (DME) with no copay and a coinsurance of up to 20%, Prosthetics/Medical Supplies with no copay and a 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 are covered, including Diagnostic Procedures/Tests with a copay between $0 and $150, and Lab Services with no copay. Outpatient X-Ray Services have a $50 copay, while Diagnostic Radiological Services have a copay between $50 and $350 and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers Home Health Services with no copay and no coinsurance, but 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 specify the copay or coinsurance. However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, and provides a maximum benefit coverage amount of $20 every three months. The plan also covers meal benefits and other services with no copay. However, 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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