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WellSense Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for WellSense Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on WellSense Signature (HMO) in 2025, please refer to our full plan details page.
WellSense Signature (HMO) is a HMO plan offered by BMC Health System, Inc. available for enrollment in 2025 to people living in All Counties_Signature. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that WellSense Signature (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 Signature (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 Signature (HMO), 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 WellSense Signature (HMO) 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, standard generic drugs have a $5 copay, while non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. The plan offers an enhanced alternative drug benefit.
Additional Benefits
The WellSense Signature (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services range from no copay to a $360 copay. Emergency services have a $125 copay, and primary care visits have a $20-$60 copay depending on the service. Preventive services, home health services, and lab services have no copay. Vision and hearing services are included, with copays for exams and coverage for eyewear and hearing aids. Dental services include a $25 copay for Medicare dental services, and additional benefits like home infusion, dialysis, and medical equipment have coinsurance or copayments.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the WellSense Signature (HMO) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, you'll pay a $365 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $360, observation services with a $365 copay, ambulatory surgical center services with a $300 copay, and outpatient substance abuse services with a $45 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the WellSense Signature (HMO) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the WellSense Signature (HMO) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 50% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the WellSense Signature (HMO) plan, with a $125 copay and no coinsurance. Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay, and Worldwide Urgent Coverage has a $40 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The WellSense Signature (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, physician specialist services with a $25 copay, mental health specialty services with a $60 copay, other health care professional services with a copay between $0 and $65, psychiatric services with a $60 copay, physical therapy and speech-language pathology services with a $65 copay, additional telehealth benefits, and opioid treatment program services with a copay between $0 and $60. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The WellSense Signature (HMO) plan covers preventive services, including annual physical exams, with no copay. Some additional preventive services like health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Hearing exams have a $25 copay, and routine hearing exams are covered once per year. Prescription hearing aids have a copay between $699 and $999, and you are eligible for 2 hearing aids per year.
Vision Services See details
Vision services are covered, including eye exams with a $25 copay. Eyewear is also covered, with a combined maximum benefit of $150 every year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services include a $25 copay for Medicare Dental Services. Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Fluoride Treatment are covered, with limitations on the number of visits per year. Orthodontic Services are covered up to a maximum of $3,500 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, with prior authorization required. 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 by the WellSense Signature (HMO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment is covered, with a 20% coinsurance for Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts 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, including all diagnostic and radiological services, as well as lab services. Diagnostic Procedures/Tests have a copay between $0 and $10. Lab Services have no copay. Diagnostic Radiological Services have a copay between $80 and $350, while Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have an $80 copay.
Home Health Services See details
Home Health Services are covered by the WellSense Signature (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 Signature (HMO) plan. The plan does not cover 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the WellSense Signature (HMO) plan, but require prior authorization. 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 SNF stays are not covered.
Other Services See details
The WellSense Signature (HMO) plan's Other Services benefit covers over-the-counter (OTC) items with a maximum benefit of $100 every three months, including nicotine replacement therapy and Naloxone. 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. The plan also covers a meal benefit for chronic illness.
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