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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 2026, 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 3.5 out of 5 stars in 2026.
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 $275.00 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 an annual drug deductible of $275. For Tier 1 preferred generic drugs, you will pay a low $3 copay for a one-month supply at preferred pharmacies and mail order, or $13 at standard pharmacies. Tier 2 generic drugs cost a $10 copay for a one-month supply through preferred networks and $20 at standard locations. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, and Tier 4 non-preferred drugs cost a $100 copay across all network pharmacies. Specialty medications in Tier 5 are subject to a 29% coinsurance for a one-month supply. You can also save on prescription costs by utilizing two-month or three-month mail-order and retail options for Tiers 1 through 4.
Additional Benefits
The Health Plan SecureChoice - Option II (PPO) offers comprehensive medical coverage with affordable out-of-pocket costs, featuring no coinsurance for many key services. Members pay a $10 copay for primary care visits, a $45 copay for specialists, and no copay for telehealth services or covered preventive care. For hospital stays, there is no coinsurance, though inpatient acute stays require a daily copay of $295 for the first six days, and outpatient hospital services carry copays ranging from no copay up to $295. This plan also includes essential supplemental benefits, such as preventive dental and routine vision exams with no copay and no coinsurance, alongside a $150 annual vision allowance. Hearing exams are available with a $20 copay, and home health services feature no copay and no coinsurance. For medical equipment and dialysis, members will pay no copay and a 20% coinsurance, while over-the-counter items are covered with no copay up to $55 every three months.
Inpatient Hospital See details
Inpatient hospital services are covered by The Health Plan SecureChoice - Option II (PPO) with no coinsurance, requiring prior authorization and a daily copay of $295 for days 1 through 6 of acute stays or $250 for days 1 through 5 of psychiatric stays, followed by no copay for remaining covered days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under The Health Plan SecureChoice - Option II (PPO) with no coinsurance for all services, though prior authorization is required for most. Patients will pay copays of $0 to $295 for outpatient hospital services, $150 per stay for observation services, $295 for ambulatory surgical center visits, and $45 for outpatient substance abuse sessions, while outpatient blood services feature no copay.
Partial Hospitalization See details
The Health Plan SecureChoice - Option II (PPO) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
The Health Plan SecureChoice - Option II (PPO) covers ambulance services with no coinsurance, requiring a $200 copay for ground ambulance and a $500 copay for air ambulance services with prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by The Health Plan SecureChoice - Option II (PPO) with a $125 copay and urgently needed services with a $45 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $25,000 lifetime maximum with no coinsurance, which includes emergency care for a $125 copay and emergency transportation for a $200 to $500 copay, though worldwide urgent care is not covered.
Primary Care See details
The Health Plan SecureChoice - Option II (PPO) covers primary care visits for a $10 copay and specialist visits for a $45 copay, both with no coinsurance. Therapy services, including physical, occupational, and speech, carry a $40 copay and no coinsurance, while telehealth options feature no copay and no coinsurance. Chiropractic services are not covered in practice, as routine and other chiropractic sub-services are excluded.
Preventive Services See details
Preventive services are partially covered under The Health Plan SecureChoice - Option II (PPO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, memory fitness, and smoking cessation. Supplemental services not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered under The Health Plan SecureChoice - Option II (PPO), which provides covered hearing exams with a $20 copay, no coinsurance, and no deductible. Routine hearing exams, fitting or evaluation services, and all prescription and over-the-counter hearing aids are not covered.
Vision Services See details
The Health Plan SecureChoice - Option II (PPO) covers vision services with no copay and no coinsurance, offering one routine eye exam per year and a $150 annual allowance for contacts, lenses, and frames. This benefit is partially covered, as upgrades, other eye exam services, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
The Health Plan SecureChoice - Option II (PPO) offers partially covered dental services, featuring Medicare-covered dental care for a $45 copay and no coinsurance, alongside preventive services like exams, cleanings, and x-rays with no copay and no coinsurance. Other services, including fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by The Health Plan SecureChoice - Option II (PPO) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by The Health Plan SecureChoice - Option II (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under The Health Plan SecureChoice - Option II (PPO) are covered with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay and a 0% to 20% coinsurance, but are limited to specified manufacturers, and prior authorization is required for medical equipment services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by The Health Plan SecureChoice - Option II (PPO), as lab services are not covered. Covered diagnostic procedures require a $50 copay and no coinsurance, while diagnostic radiology has no copay, outpatient X-rays require a $50 copay, and therapeutic radiology requires a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by The Health Plan SecureChoice - Option II (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under The Health Plan SecureChoice - Option II (PPO), as none of the sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered by the plan.
Skilled Nursing Facility (SNF) See details
The Health Plan SecureChoice - Option II (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
The Health Plan SecureChoice - Option II (PPO) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $55 every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this plan.
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