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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 2026, 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 3 out of 5 stars in 2026.
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 $21.70. 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 $615.00 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 $8750.00 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 features an annual prescription drug deductible of $615. This represents the amount you must pay out-of-pocket for your medications before your prescription drug coverage begins to pay. Detailed information regarding specific drug tiers, copayments, and coinsurance is not available for this plan. Beneficiaries should consult the plan formulary or contact the provider directly to determine the exact costs for their specific medications.
Additional Benefits
The WellSense Added Value (HMO) plan offers comprehensive medical coverage with no copays for primary care, specialist visits, and outpatient services, though a 20% coinsurance typically applies. Inpatient hospital stays require a copay for the first few days, such as $610 daily for days 1 through 4 of an acute stay, followed by no copay for days 5 through 90. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes key supplemental benefits, such as home health services with no copay and no coinsurance. Dental and vision benefits are covered up to annual limits, featuring no copays and maximum allowances of $1,000 for dental care and $400 for eyewear. Additionally, members can access an over-the-counter benefit of up to $250 every three months with no copay or coinsurance for approved health products.
Inpatient Hospital See details
WellSense Added Value (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, although additional days, upgrades, and non-Medicare-covered stays are not covered. Acute stays require a $610 copay for days 1 through 4 and no copay for days 5 through 90, while psychiatric stays require a $415 copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Outpatient services are covered by WellSense Added Value (HMO) with no copays, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for ambulatory surgical center services.
Partial Hospitalization See details
WellSense Added Value (HMO) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
WellSense Added Value (HMO) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are not covered under this plan.
Emergency Services See details
Emergency services are covered by WellSense Added Value (HMO) with a $115 copay and no coinsurance, and urgently needed services are covered with a $40 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. For worldwide emergency services, some services are covered but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
WellSense Added Value (HMO) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, although prior authorization is required for some benefits. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
WellSense Added Value (HMO) covers preventive services, including annual physicals and kidney disease education, with no copay and no coinsurance. However, this benefit is partially covered, as it excludes fitness benefits, weight management, personal emergency response systems, health education, in-home safety assessments, alternative therapies, and adult day health services.
Hearing Services See details
WellSense Added Value (HMO) partially covers hearing services, providing one routine hearing exam annually with no copay, 20% coinsurance, and no deductible, though fitting and evaluations and OTC hearing aids are not covered. For prescription hearing aids, some services are covered, but all types, including inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
Vision services are partially covered by WellSense Added Value (HMO), excluding other eye exam services. Routine eye exams are covered with no copay and a 20% coinsurance, while eyewear—including contacts, frames, lenses, and upgrades—is covered with no copay and no coinsurance, up to a combined $400 annual maximum.
Dental Services See details
WellSense Added Value (HMO) offers partially covered dental services, including Medicare-covered dental with no copay and 20% coinsurance, alongside preventive and comprehensive care with no copay and no coinsurance up to a $1,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
WellSense Added Value (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Under this plan, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
WellSense Added Value (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
WellSense Added Value (HMO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
WellSense Added Value (HMO) partially covers diagnostic services and fully covers radiological services, with all covered services requiring prior authorization, no copay, and a 20% coinsurance. While diagnostic procedures, therapeutic radiology, and X-rays are covered, lab services are not covered under this benefit.
Home Health Services See details
WellSense Added Value (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the WellSense Added Value (HMO) plan with no copay, though some services are not covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by WellSense Added Value (HMO) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by WellSense Added Value (HMO), which offers over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $250 every three months for approved items, but unused balances do not carry over.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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