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Primewell Giveback (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Primewell Giveback (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Primewell Giveback (HMO-POS) in 2025, please refer to our full plan details page.
Primewell Giveback (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 Giveback (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 Giveback (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 Giveback (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 $60.00. 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 a $195.00 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 $5900.00 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 Giveback (HMO-POS) plan has a $195 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay a $12 copay at preferred pharmacies and a $18 copay at standard pharmacies. For preferred brand drugs, you will pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Primewell Giveback (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $295 copay for the first seven days, while outpatient services have copays ranging from $0 to $350. Emergency services have a $125 copay, and primary care visits are covered with no copay. Additional benefits include no copay for preventive services, hearing exams, and vision eyewear. Dental services are covered with no copay up to a $2,200 annual maximum. The plan also includes coverage for home infusion, dialysis, medical equipment, and diagnostic services, with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $295 copay for days 1-7 and no copay for days 8-90. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Primewell Giveback (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $60.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Primewell Giveback (HMO-POS) plan. Ground Ambulance Services have a $250 copay, and Air Ambulance Services have a $300 copay, but Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Primewell Giveback (HMO-POS) plan, with a $125 copay and no coinsurance, and the copay is waived if admitted to the hospital within 72 hours. Urgently Needed Services have a $50 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay and no coinsurance, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Primewell Giveback (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. The plan also covers physician specialist services with a $30 copay, and mental health specialty services with a $40 copay for individual or group sessions. Additional benefits include a $35 copay for physical therapy and speech-language pathology services, and telehealth benefits with a copay between $0 and $40. Opioid treatment program services have a $40 copay. Podiatry Services are not covered.
Preventive Services See details
The Primewell Giveback (HMO-POS) plan covers preventive services, including no copay for Medicare-covered services, annual physical exams, Home-Based Palliative Care, and Fitness Benefit. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The Primewell Giveback (HMO-POS) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. The plan also covers prescription hearing aids, but does not specify the copay. OTC hearing aids are covered with no copay. The plan does not cover Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, or Prescription Hearing Aids - Over the Ear.
Vision Services See details
The Primewell Giveback (HMO-POS) plan covers vision services, including eye exams with a $30 copay. The plan also covers eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, all with no copay and a combined maximum benefit of $500 per year.
Dental Services See details
The Primewell Giveback (HMO-POS) plan covers 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, with a $2,200 annual maximum. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Primewell Giveback (HMO-POS) plan, which includes Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Primewell Giveback (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered under the Primewell Giveback (HMO-POS) plan, including 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 include coverage for diagnostic procedures and tests with a copay of $0-$30, and lab services with no copay. Radiological Services include coverage for diagnostic services with a copay of up to $200, therapeutic services with a coinsurance of up to 20%, and outpatient X-ray services with no coinsurance.
Home Health Services See details
Home Health Services are covered by the Primewell Giveback (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Primewell Giveback (HMO-POS) plan, but none of the sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Primewell Giveback (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $200 copay for days 21-100.
Other Services See details
The Primewell Giveback (HMO-POS) plan does not cover acupuncture, meal benefits, or Dual Eligible SNPs with Highly Integrated Services, as well as several other services. Over-the-Counter (OTC) Items are covered, but do not include nicotine replacement therapy or Naloxone coverage.
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