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The Health Plan SecureChoice Optimum (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for The Health Plan SecureChoice Optimum (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 Optimum (PPO) in 2025, please refer to our full plan details page.
The Health Plan SecureChoice Optimum (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 Optimum (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 Optimum (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 Optimum (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 $9550.00 (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 $9550.00 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:
Sign up for The Health Plan SecureChoice Optimum (PPO)
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Drug Coverage
The Health Plan SecureChoice Optimum (PPO) has an "Enhanced Alternative" drug benefit. There is no deductible for this plan. In the initial coverage phase, you will pay no copay for preferred generic drugs at preferred pharmacies and preferred mail-order pharmacies. For other drugs, you will pay coinsurance, starting at 20% and increasing based on the drug tier. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The Health Plan SecureChoice Optimum (PPO) offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Primary care visits have no copay, while specialist visits and mental health services have a copay of $45. The plan also covers preventive, hearing, vision, and dental services with copays and other cost-sharing. Emergency, ambulance, and home health services are covered, with copays for emergency and ambulance services, and no cost for home health. Additional benefits include coverage for home infusion and medical equipment with varying cost-sharing, as well as over-the-counter items up to $200 every three months. This plan also covers skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, the copay is $350, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $500, observation services have a $500 copay, and ambulatory surgical center services have a $500 copay. Individual and group sessions for outpatient substance abuse have a copay of $45, and outpatient blood services have a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by The Health Plan SecureChoice Optimum (PPO) plan, but requires prior authorization. There is no information about cost or coverage details for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by The Health Plan SecureChoice Optimum (PPO). Ground Ambulance Services have a $250 copay, while Air Ambulance Services have a $500 copay; there is no coinsurance for either service. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by The Health Plan SecureChoice Optimum (PPO). Emergency Services have a $125 copay, and Urgently Needed Services have a $40 copay, and both have no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage is not covered, and Worldwide Emergency Transportation has a copay between $250 and $500; all have no coinsurance.
Primary Care See details
The Health Plan SecureChoice Optimum (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, and Occupational Therapy Services with a $40 copay. The plan also covers Physician Specialist Services with a $45 copay, and Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services with a minimum and maximum copay of $45. Physical Therapy and Speech-Language Pathology Services have a $40 copay, while Additional Telehealth Benefits are also covered.
Preventive Services See details
Preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services are covered. Health education, additional sessions of smoking and tobacco cessation counseling, and fitness benefits are covered. However, 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 benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, 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
Hearing Services includes coverage for hearing exams with a $45 copay, and routine hearing exams once per year. Fitting/Evaluation for Hearing Aids is covered, and Prescription Hearing Aids are covered up to two times every two years with a copay between $599 and $899. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Health Plan SecureChoice Optimum (PPO) covers routine eye exams once per year, and eyewear, including contact lenses, eyeglass lenses, and frames, with a combined maximum benefit of $200 per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Health Plan SecureChoice Optimum (PPO) plan covers Medicare Dental Services with a $45 copay and other dental services, including oral exams, dental x-rays, prophylaxis (cleaning), and prosthodontics. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum plan benefit coverage of $1500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by The Health Plan SecureChoice Optimum (PPO) with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies are covered with 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $50 copay, and Diagnostic Radiological Services with a copay up to $150. 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 by The Health Plan SecureChoice Optimum (PPO), with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by The Health Plan SecureChoice Optimum (PPO). Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The Health Plan SecureChoice Optimum (PPO) plan does not cover acupuncture, meal benefits, 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. This plan does provide coverage for Over-the-Counter (OTC) Items up to $200 every three months.
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