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Primewell Reliance (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Primewell Reliance (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Primewell Reliance (HMO-POS) in 2025, please refer to our full plan details page.
Primewell Reliance (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 Reliance (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 Reliance (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 Reliance (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.30. 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 $3900.00 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 Reliance (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for generic drugs, and coinsurance for brand-name and non-preferred drugs. For preferred generic drugs, the copay is $12.00 at preferred pharmacies and mail order, and $14.00 at standard pharmacies. For standard generic drugs, the copay is $45.00 at preferred pharmacies and mail order, and $47.00 at standard pharmacies. Brand-name and non-preferred drugs have a 50% and 33% coinsurance, respectively.
Additional Benefits
The Primewell Reliance (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services range from no copay to a $250 copay. Emergency services, primary care, preventive services, hearing, vision, and dental services have several services with no copay. This plan also provides coverage for ambulance services, with copays for ground and air transport. Home health services are covered with no copay, and skilled nursing facility stays have no copay for the first 20 days, with a copay for additional days. The plan also covers diagnostic, radiological, and home infusion services, along with medical equipment, with associated coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $205 copay for days 1-10, and no copay for days 11-90. For Inpatient Hospital Psychiatric, you will pay a $225 copay for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $250, and observation services with a $205 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $30 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Primewell Reliance (HMO-POS) plan. This benefit has a $60 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a $250 copay, and Air Ambulance Services have a $260 copay, with no coinsurance. 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 by the Primewell Reliance (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $40 copay, and all have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Primewell Reliance (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $35 copay. This plan also covers physician specialist services with a $25 copay, mental health specialty services with a $30 copay for individual and group sessions, and physical therapy with a $35 copay. Additionally, additional telehealth benefits are available with a copay between $0 and $35, and opioid treatment program services are covered with a $40 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Primewell Reliance (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services include coverage for Personal Emergency Response Systems (PERS), Home-Based Palliative Care, and Fitness Benefits; however, services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Primewell Reliance (HMO-POS) covers hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. This plan also covers prescription hearing aids, with a maximum plan benefit coverage of $900 every year, and OTC hearing aids with no copay. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services are covered, including eye exams, routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eye exams have a $25 copay, while routine eye exams and eyewear have no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades also have no copay. Eyewear has a combined maximum benefit of $450 per year.
Dental Services See details
The Primewell Reliance (HMO-POS) plan covers a range of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, all with no copay. Other dental services have a maximum plan benefit of $2,400 every year, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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 under the Primewell Reliance (HMO-POS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a minimum copay of $0 for Diagnostic Procedures/Tests, and a copay of at most $100 for Diagnostic Radiological Services. Lab Services have no copay, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Primewell Reliance (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Primewell Reliance (HMO-POS) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Primewell Reliance (HMO-POS) plan. There is no copay for days 1-20, and a $165 copay for days 21-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for over-the-counter items, but acupuncture, meal benefits, 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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