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The Health Plan SecureChoice - Option II (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for The Health Plan SecureChoice - Option II (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on The Health Plan SecureChoice - Option II (PPO) in 2025, please refer to our full plan details page.
The Health Plan SecureChoice - Option II (PPO) is a PPO plan offered by The Health Plan of West Virginia, Inc. available for enrollment in 2025 to people living in Ohio, West Virginia. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that The Health Plan SecureChoice - Option II (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 The Health Plan SecureChoice - Option II (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 The Health Plan SecureChoice - Option II (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $109.00. 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 has a $1500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $100.00 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 $10000.00 (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 $10000.00 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 Health Plan SecureChoice - Option II (PPO) has a $100 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, with the amount varying based on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies and $20 at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. The plan's premium may be reduced if you qualify for the low-income subsidy, and the Part D cost is $43.50 with LIS.
Additional Benefits
The Health Plan SecureChoice - Option II (PPO) offers a range of benefits with varying cost-sharing. This plan covers inpatient hospital stays with copays, and outpatient services with copays ranging from $0 to $295. It also includes coverage for ambulance services, emergency services, primary care, preventive services, vision, dental, home infusion, dialysis, medical equipment, diagnostic services, and skilled nursing facility services, each with its own copay or coinsurance structure. Additional benefits include coverage for hearing exams, with a copay, and offers an over-the-counter (OTC) items benefit. However, the plan has limitations, such as not covering certain vision and dental services, and specific medical equipment uses. Additionally, some services, like home health and skilled nursing facilities, require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by The Health Plan SecureChoice - Option II (PPO). For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $295, observation services with a $150 copay, ambulatory surgical center services with a $295 copay, and outpatient substance abuse services with a $45 copay for individual and group sessions. Outpatient blood services are also covered, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information available about the cost of the benefit, including the copay, deductible, and coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by The Health Plan SecureChoice - Option II (PPO). Ground ambulance services have a $200 copay, and air ambulance services have a $500 copay, with no coinsurance for either. Transportation services to a health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Transportation have a copay, while Worldwide Emergency Coverage has a $125 copay, and Urgently Needed Services has a $45 copay. Worldwide Emergency Transportation has a $200-$500 copay. Worldwide Urgent Coverage is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $25,000.
Primary Care See details
The Health Plan SecureChoice - Option II (PPO) covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, physician specialist services with a $45 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $45 copay, other health care professional services with a $45 copay, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, opioid treatment program services with a $45 copay, and additional telehealth benefits. Routine chiropractic care is not covered.
Preventive Services See details
The Health Plan SecureChoice - Option II (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services, with some services like in-home safety assessments and personal emergency response systems not covered. The plan also covers health education, additional sessions of smoking and tobacco cessation counseling (up to 8 visits), fitness benefits (memory fitness), kidney disease education services, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following Welcome Visits.
Hearing Services See details
Hearing Services are partially covered by The Health Plan SecureChoice - Option II (PPO). Hearing exams have a $45 copay, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
The Health Plan SecureChoice - Option II (PPO) covers vision services, including routine eye exams with one exam covered every year. Eyewear is covered, with a combined maximum benefit of $150 per year for both in-network and out-of-network services, and contact lenses, eyeglass lenses, and frames are covered with limitations. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $45 copay, oral exams (2 visits per year), dental x-rays (one set of bitewing x-rays per year, and one panoramic radiographic image every three years), and prophylaxis (cleaning) with 2 visits per year. Fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and no copay. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with Diagnostic Procedures/Tests requiring a $50 copay, and Diagnostic Radiological Services having a maximum copay of $150.00. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $45.00 every three months, and does not cover Acupuncture, Meal Benefit, 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.
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