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WellSense Signature Access (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for WellSense Signature Access (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on WellSense Signature Access (PPO) in 2026, please refer to our full plan details page.
WellSense Signature Access (PPO) is a PPO plan offered by BMC Health System, Inc. available for enrollment in 2025 to people living in Hillsborough_Access. The overall rating for this plan is not yet available for 2026.
It's important to know that WellSense Signature Access (PPO) 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 Access (PPO).
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 Access (PPO), 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 combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Access (PPO) plan features an annual drug deductible of $495. For Tier 1 preferred generic drugs, there is no copay for 1-month or 3-month supplies at standard retail pharmacies and standard mail order. Tier 2 generic drugs also have no copay when filled through standard mail order, while standard retail pharmacies charge a $10 copay for a 1-month supply or a $25 copay for a 3-month supply. Tier 3 preferred brand drugs cost a $47 copay at standard retail pharmacies and a $45 copay through standard mail order for a 1-month supply. Tier 4 non-preferred drugs carry a $100 copay for standard retail and a $97 copay for standard mail order for a 1-month supply. High-cost Tier 5 specialty drugs require a 27% coinsurance for 1-month supplies at both standard retail and standard mail order.
Additional Benefits
The WellSense Signature Access (PPO) plan offers robust coverage for everyday healthcare needs, featuring no copays or coinsurance for primary care visits, home health services, and routine preventive care. For specialized medical needs, members will pay a $45 copay for specialist visits, while emergency room visits require a $130 copay and urgent care services carry a $50 copay. Inpatient hospital stays require daily copays for the first several days before transitioning to no copay, and outpatient services range from no copay up to a $395 copay, all with no coinsurance. This plan also provides valuable supplemental benefits, including routine dental exams with no copay and comprehensive dental coverage at a 50% coinsurance up to a $2,000 annual limit. Routine vision and hearing exams are available with a $45 copay, alongside a $150 annual allowance for eyewear and coverage for up to two prescription hearing aids per year. Additionally, members benefit from an over-the-counter item allowance of $50 every three months, while durable medical equipment and dialysis services generally require a 20% coinsurance with no copays.
Inpatient Hospital See details
WellSense Signature Access (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though additional days, upgrades, and non-Medicare-covered stays are not covered. Acute stays require prior authorization and a $420 copayment for days 1 through 7 with no copayment for days 8 through 90, while psychiatric stays require a $390 copayment for days 1 through 6 with no copayment for days 7 through 90.
Outpatient Services See details
WellSense Signature Access (PPO) covers outpatient services with no coinsurance, offering outpatient hospital copays from no copay up to $395, and observation services at a $420 daily copay. Ambulatory surgical center services require a $350 copay with prior authorization, outpatient substance abuse sessions have a $45 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
WellSense Signature Access (PPO) covers partial hospitalization services with a copayment of $140.00 or $145.00 and no coinsurance.
Ambulance and Transportation Services See details
WellSense Signature Access (PPO) covers ground ambulance services with a $350 copay and air ambulance services with a 50% coinsurance, with prior authorization required for all transports. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the WellSense Signature Access (PPO) are covered with a $130 copay and no coinsurance, while urgently needed services require a $50 copay and no coinsurance, with both copays waived if hospital admission occurs within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with no coinsurance and matching copays, but worldwide emergency transportation is not covered.
Primary Care See details
WellSense Signature Access (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits and occupational therapy require a $45 copay and no coinsurance. Physical and speech therapy have a $65 copay with no coinsurance, mental health and psychiatric sessions require a $60 copay with no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
WellSense Signature Access (PPO) covers preventive services, such as annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management, with no copay and no coinsurance. Additional preventive services are partially covered; remote access technologies are covered, but health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, fitness benefits, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
WellSense Signature Access (PPO) offers partially covered hearing services, featuring a $45 copay and no coinsurance for annual routine hearing exams and unlimited fitting evaluations. Up to two prescription hearing aids are covered per year with a copay ranging from $699 to $999 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by WellSense Signature Access (PPO), which excludes other eye exam services but covers one routine eye exam annually with a $45 copay and no coinsurance. Eyewear, including contacts, eyeglasses, frames, lenses, and upgrades, is covered with no copay and no coinsurance up to a combined maximum of $150 per year.
Dental Services See details
Dental services are partially covered by WellSense Signature Access (PPO), offering Medicare-covered dental services for a $45 copay and no coinsurance, and preventive services with no copay and no coinsurance. Comprehensive dental care is covered with no copay and 50% coinsurance up to a $2,000 annual maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
WellSense Signature Access (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by WellSense Signature Access (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
WellSense Signature Access (PPO) covers medical equipment with no copays, though prior authorization is required. Covered items, including durable medical equipment, prosthetics, medical supplies, and diabetic shoes, carry a 20% coinsurance, while diabetic supplies range from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
WellSense Signature Access (PPO) covers diagnostic and radiological services with prior authorization. Diagnostic tests have no coinsurance and a $0 to $10 copay, lab services have no copay or coinsurance, and radiological services require an $80 copay for X-rays and diagnostic imaging or a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by WellSense Signature Access (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
WellSense Signature Access (PPO) provides Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Patients face copays of $40 for cardiac rehabilitation, $50 for intensive cardiac rehabilitation, $35 for pulmonary rehabilitation, and $25 for SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by WellSense Signature Access (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100-day Medicare-covered limit are not covered.
Other Services See details
WellSense Signature Access (PPO) provides partial coverage for other services with no copay and no coinsurance for a chronic illness meal benefit and over-the-counter (OTC) items up to $50 every three months. Acupuncture and other additional services are not covered under this plan.
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