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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 2025, 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 All Counties_Access. The overall rating for this plan is not yet available for 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9900.00 (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 $9900.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, generic drugs have a $5 copay at a standard pharmacy, while preferred mail-order generic drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The WellSense Signature Access (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays, as well as coverage for emergency services. Primary care, hearing, vision, and dental services are also included, with specific copays for exams and other services. The plan also offers coverage for home health, home infusion, and skilled nursing facilities with specific cost-sharing arrangements. Additional benefits include coverage for ambulance, home infusion, and dialysis services with coinsurance or copays. The plan also covers medical equipment, diagnostic and radiological services, and a limited over-the-counter allowance. However, some services like cardiac rehabilitation, acupuncture, and certain types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which have a $370 copay for days 1-6, and no copay for days 7-90. Additional days, and non-medicare covered stays for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay of $0-$365, observation services with a copay of $370, and ambulatory surgical center services with a copay of $300. Outpatient substance abuse services are covered with a copay of $45 for both individual and group sessions, while outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the WellSense Signature Access (PPO) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a $295 copay, while Air Ambulance Services have a 50% 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 under the WellSense Signature Access (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage also has a $125 copay. Worldwide Urgent Coverage has a $40 copay, while Worldwide Emergency Transportation is not covered. There is no coinsurance for these services.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the WellSense Signature Access (PPO) plan. Chiropractic services have a $20 copay, Occupational Therapy Services have a $45 copay, Physician Specialist Services have a $30 copay, Individual and Group Sessions for Mental Health Specialty Services have a $60 copay, Other Health Care Professional services have a copay between $0 and $65, Individual and Group Sessions for Psychiatric Services have a $60 copay, Physical Therapy and Speech-Language Pathology Services have a $65 copay, and Opioid Treatment Program Services have a copay between $0 and $60. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered by the WellSense Signature Access (PPO) plan. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids are covered, with unlimited visits. Prescription hearing aids are covered, with a copay between $699 and $999 for all types, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The WellSense Signature Access (PPO) plan covers vision services, including eye exams with a $30 copay. Eyewear is covered up to a combined maximum of $150 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $30 copay, as well as coverage for other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. This plan does not cover maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the WellSense Signature Access (PPO) plan. 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 WellSense Signature Access (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices, and Medical Supplies with 20% coinsurance. Diabetic Supplies are covered with between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a copay between $0 and $10, Lab Services have no copay, Diagnostic Radiological Services have a copay between $80 and $350, and Outpatient X-Ray Services have an $80 copay, while Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the WellSense Signature Access (PPO) plan with no copay and no coinsurance; however, 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 WellSense Signature Access (PPO) plan. The plan does not cover any of the sub-services for Cardiac Rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the WellSense Signature Access (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The WellSense Signature Access (PPO) plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. Over-the-counter items are covered with a maximum benefit of $75.00 every three months, and the plan offers a meal benefit for a chronic illness.
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