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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 2026, 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 Hillsborough_Signature. This plan received an overall rating of 3 out of 5 stars in 2026.
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 a $495.00 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 $6550.00 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) Medicare plan features an annual drug deductible of $495. For prescription drug coverage, Tier 1 preferred generic medications have no copay for both one-month and three-month supplies at standard pharmacies and through standard mail order. Tier 2 generic drugs also feature no copay for standard mail-order refills, while standard pharmacy pickups require a $10 copay for a one-month supply and a $25 copay for a three-month supply. For brand-name and specialty medications, Tier 3 preferred brands cost $47 at standard pharmacies and $45 via standard mail order for a one-month supply. Tier 4 non-preferred drugs require a $100 copay at standard pharmacies or $97 through mail order for one month, with three-month supplies costing $280 and $275 respectively. Finally, Tier 5 specialty drugs require a 27% coinsurance for a one-month supply through both standard pharmacies and standard mail order.
Additional Benefits
The WellSense Signature (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and routine preventive care. Specialist visits require a $35 copay, while inpatient hospital stays carry a $420 daily copay for the first seven days of acute stays. Emergency room visits have a $130 copay, which is completely waived if you are admitted to the hospital within 24 hours. Dental benefits include no copay for preventive care and up to $2,000 for comprehensive services with a 50% coinsurance. Routine vision and hearing exams both require a $35 copay, but members receive a $150 annual eyewear allowance and prescription hearing aid coverage with copays starting at $699. Members also enjoy no copay for home infusion services and a $45 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by WellSense Signature (HMO) with no coinsurance, requiring a $420 daily copay for days 1-7 of acute stays and a $390 daily copay for days 1-6 of psychiatric stays, followed by no copay for remaining days up to day 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
WellSense Signature (HMO) covers outpatient hospital services with a $0 to $395 copay and no coinsurance, observation services with a $420 daily copay and no coinsurance, and ambulatory surgical center services with a $350 copay and no coinsurance. Outpatient substance abuse sessions carry a $45 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by WellSense Signature (HMO) with a copay of either $140.00 or $145.00 and no coinsurance.
Ambulance and Transportation Services See details
WellSense Signature (HMO) covers ground ambulance services with a $350 copay and no coinsurance, and air ambulance services with a 50% coinsurance and no copay, with prior authorization required for both. Plan-approved and health-related transportation services are not covered.
Emergency Services See details
Emergency services are covered by WellSense Signature (HMO) with a $130 copay and no coinsurance, and urgently needed services are covered with a $50 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum limit with a $130 copay for emergency care and a $50 copay for urgent care (both with no coinsurance), but worldwide emergency transportation is not covered.
Primary Care See details
WellSense Signature (HMO) covers primary care provider visits with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Additional services like physical, occupational, and mental health therapies are covered with copays ranging from $45 to $65 and no coinsurance, though podiatry services are not covered.
Preventive Services See details
WellSense Signature (HMO) partially covers preventive services with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and remote access technologies. However, several additional services are not covered, including health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, fitness, disease management, telemonitoring, safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by WellSense Signature (HMO) with no deductible, featuring routine exams for a $35 copay and prescription hearing aids for a $699 to $999 copay, both with no coinsurance. This benefit is partially covered, as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
WellSense Signature (HMO) offers partially covered vision services, featuring one routine eye exam per year with a $35 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $150 annual limit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by WellSense Signature (HMO), including Medicare-covered dental for a $35 copay and no coinsurance, and preventive services with no copay and no coinsurance. Comprehensive services are covered up to a $2,000 annual maximum with no copay and 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
WellSense Signature (HMO) covers home infusion bundled services with no copay, requiring prior authorization. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the WellSense Signature (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
WellSense Signature (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic services, with no copay and a required prior authorization. Most covered equipment and supplies require a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
WellSense Signature (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $10 copay for diagnostic tests. Radiological services require prior authorization and carry an $80 copay for X-rays and diagnostic radiology, as well as a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the WellSense Signature (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
WellSense Signature (HMO) covers Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered, but Cardiac Rehabilitation (with a $40 copay), Intensive Cardiac Rehabilitation ($50 copay), Pulmonary Rehabilitation ($35 copay), and Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
WellSense Signature (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by WellSense Signature (HMO), featuring no copay and no coinsurance for chronic illness meal benefits and over-the-counter (OTC) items up to $45 every three months, while acupuncture is not covered.
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