A non-government entity
WellSense Senior Care Options (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for WellSense Senior Care Options (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on WellSense Senior Care Options (HMO D-SNP) in 2025, please refer to our full plan details page.
WellSense Senior Care Options (HMO D-SNP) is a HMO D-SNP plan offered by BMC Health System, Inc. available for enrollment in 2025 to people living in Barnstable, Bristol, Hampden, Plymouth, Suffolk. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that WellSense Senior Care Options (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
WellSense Senior Care Options (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about WellSense Senior Care Options (HMO D-SNP).
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 Senior Care Options (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $52.50. 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 $590.00 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 Maximum Out-Of-Pocket cost of $7100.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 WellSense Senior Care Options (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The WellSense Senior Care Options (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), you will pay $52.50 for Part D. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The WellSense Senior Care Options (HMO D-SNP) plan offers a variety of benefits with varying cost-sharing. Many services, including primary care, outpatient services, and vision services, have a 20% coinsurance. Some services, like preventive services, home health services, and diagnostic and radiological services, have no copay. The plan also includes coverage for hearing, dental, and medical equipment, each with their own cost-sharing structures. Additionally, the plan provides coverage for home infusion, dialysis, and other services, such as OTC items. Be sure to consult the plan documents for full details on all the services covered by the plan, and the specific cost sharing details.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days for each, as well as non-Medicare-covered stays and upgrades, are not covered. You will have to pay the Medicare-defined cost share for tier 1, and prior authorization is required.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services; each service has a 20% coinsurance. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered, with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the WellSense Senior Care Options (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, with no copay. 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 Senior Care Options (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The WellSense Senior Care Options (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and physical therapy and speech-language pathology services have a 20% coinsurance. Occupational Therapy Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have a coinsurance of 20%. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered services with no copay and additional preventive services. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered under the WellSense Senior Care Options (HMO D-SNP) plan. While hearing exams are covered with at most 20% coinsurance and no deductible, routine hearing exams and fitting/evaluation for hearing aids are not covered, nor are any prescription or OTC hearing aids.
Vision Services See details
Vision services are covered under the WellSense Senior Care Options (HMO D-SNP) plan. Eye exams have a 20% coinsurance, while routine eye exams are not covered. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have a 20% coinsurance. There is a combined maximum benefit of $325 per year for all eyewear.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%, while Insulin and Medicare Part B Insulin Drugs are covered.
Dialysis Services See details
Dialysis Services are covered under the WellSense Senior Care Options (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The WellSense Senior Care Options (HMO D-SNP) plan covers Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a coinsurance of 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for any services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the WellSense Senior Care Options (HMO D-SNP) plan with no copay and no coinsurance, but 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 covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The coinsurance information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered. Prior authorization is required, and the coinsurance details can be found in the plan documents.
Other Services See details
The WellSense Senior Care Options (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $155.00 every month, and Nicotine Replacement Therapy (NRT) and Naloxone are offered as Part C OTC benefits. Acupuncture, Meal Benefits, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved