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WellSense Added Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for WellSense Added Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on WellSense Added Value (HMO) in 2025, please refer to our full plan details page.
WellSense Added Value (HMO) is a HMO plan offered by BMC Health System, Inc. available for enrollment in 2025 to people living in All Counties_Value. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that WellSense Added Value (HMO) 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 WellSense Added Value (HMO).
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 WellSense Added Value (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $33.80. 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 $590.00 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 $8850.00 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 WellSense Added Value (HMO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you pay the cost-sharing for your drugs based on the drug tier and pharmacy. Once your total drug costs reach $2000, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for your Part D covered drugs.
Additional Benefits
The WellSense Added Value (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and partial hospitalization have 20% coinsurance. Emergency services have a copay, and primary care, hearing, vision, and dental services are covered with coinsurance. This plan also includes coverage for home health services with no copay, and offers additional benefits such as medical equipment and home infusion services with coinsurance. Additionally, there are benefits for over-the-counter items and a meal benefit for chronic illness. However, certain services like cardiac rehabilitation and some transportation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you'll pay a $595 copay for days 1-4, and no copay for days 5-90. For Inpatient Hospital Psychiatric, you'll pay a $405 copay for days 1-5, and no copay for days 6-90; additional days, and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered under the WellSense Added Value (HMO) plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Individual and Group Sessions for Outpatient Substance Abuse have a coinsurance between 20% and 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the WellSense Added Value (HMO) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the WellSense Added Value (HMO) plan, with a $110 copay and no coinsurance. Urgently Needed Services are also covered, with a $45 copay and no coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
The WellSense Added Value (HMO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. The plan has a 20% coinsurance for Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services. The plan does not cover Podiatry Services, and routine chiropractic care is not covered.
Preventive Services See details
The WellSense Added Value (HMO) plan covers preventive services, including Medicare-covered preventive services with prior authorization, annual physical exams, and additional services like fitness benefits and remote access technologies. However, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing services include coverage for routine hearing exams with a 20% coinsurance, limited to one exam per year, while fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
WellSense Added Value (HMO) covers vision services, including routine eye exams with a 20% coinsurance, and eyewear with a combined maximum benefit of $400 every year. Contact lenses, eyeglass lenses and frames, and upgrades are also covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, and other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, with specific limits on visits. Orthodontic services are covered up to a maximum of $1,500 per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the WellSense Added Value (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetics and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the WellSense Added Value (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the WellSense Added Value (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the WellSense Added Value (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The WellSense Added Value (HMO) plan's Other Services include Over-the-Counter (OTC) Items with a maximum benefit of $275 every three months, and a Meal Benefit for chronic illness with no maximum. 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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