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Primewell Classic (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Primewell Classic (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Primewell Classic (HMO-POS) in 2025, please refer to our full plan details page.
Primewell Classic (HMO-POS) is a HMO-POS plan offered by Louisiana Health Service & Indemnity Company available for enrollment in 2025 to people living in North, Central, and South Mississippi. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Primewell Classic (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 Primewell Classic (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 Primewell Classic (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. Additionally, this plan comes with a Part B Premium reduction of $0.60. You must continue to pay paying your reduced 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 $4400.00 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 Primewell Classic (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 the pharmacy you use. For example, for preferred generic drugs, you will pay a $12 copay at a preferred pharmacy, while standard generic drugs have a $45 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Primewell Classic (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with varying copays depending on the length of stay and type of care. Outpatient services, such as primary care visits, have no copay, while specialist visits have a $30 copay. The plan also covers emergency services with a $125 copay and offers coverage for hearing, vision, and dental services, often with no copay for routine exams and cleanings. Additional benefits include coverage for ambulance services, with copays for ground and air transport, and home health services with no copay. The plan also covers diagnostic and radiological services with varying copays or coinsurance amounts, and skilled nursing facility stays with a copay after the first 20 days. You will pay 20% coinsurance for dialysis services.
Inpatient Hospital See details
Inpatient Hospital coverage under the Primewell Classic (HMO-POS) plan includes acute and psychiatric care, with a copay of $245 per day for days 1-10, and no copay for days 11-90 for acute care, and a copay of $225 per day for days 1-8, and no copay for days 9-90 for psychiatric care. Additional days for inpatient hospital-acute, non-Medicare-covered stays for inpatient hospital-acute, upgrades for inpatient hospital-acute, additional days for inpatient hospital psychiatric, and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a copay between $0 and $350, Observation Services have a $245 copay, Individual and Group Sessions for Outpatient Substance Abuse have a $40 copay, and Ambulatory Surgical Center (ASC) Services have no copay.
Partial Hospitalization See details
Primewell Classic (HMO-POS) covers partial hospitalization with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Primewell Classic (HMO-POS) plan. Medicare-covered ground ambulance services have a $250 copay, and Medicare-covered air ambulance services have a $260 copay, with no coinsurance for either. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Primewell Classic (HMO-POS) plan. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a $40 copay with no coinsurance, and Worldwide Emergency Coverage has a $125 copay with no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Primewell Classic (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and specialist services with a $30 copay. Mental health specialty services, including individual and group sessions, have a $40 copay, while physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $40.
Preventive Services See details
The Primewell Classic (HMO-POS) plan covers a range of preventive services, including annual physical exams, kidney disease education, and other preventive services like glaucoma screening and diabetes self-management training. However, it does not cover health education, in-home safety assessments, personal emergency response systems, or several other additional preventive services.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams and routine hearing exams have no copay. Fitting/evaluation for hearing aids has no copay, and is limited to one visit per year. Prescription hearing aids are covered up to $1,100 every year, with no copay. OTC hearing aids have no copay.
Vision Services See details
Vision services are covered, including eye exams with a $30 copay, routine eye exams with no copay, and eyewear with no copay, which includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $500 per year.
Dental Services See details
The Primewell Classic (HMO-POS) plan covers a variety of dental services, including oral exams, dental X-rays, other diagnostic services, cleanings, fluoride treatments, restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, implant services, fixed prosthodontics, and oral and maxillofacial surgery, all with no copay. The plan has a $2,200 annual maximum for other dental services, and orthodontics and maxillofacial prosthetics 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 a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Primewell Classic (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Primewell Classic (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Primewell Classic (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $200, and Therapeutic and Outpatient X-Ray Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the Primewell Classic (HMO-POS) 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 covered under the Primewell Classic (HMO-POS) plan, but the specific services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Primewell Classic (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $165.00. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, but acupuncture, meal benefits, and other services are not covered. This plan does offer Over-the-Counter (OTC) Items as a supplemental benefit under Part C.
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