Wellpoint Medicare Advantage 2 (HMO-POS)
Available to residents of Guadalupe County, TX for 2026. Contract H2593, plan 029, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Guadalupe County
- Plan website
- Browse the Wellpoint Medicare Advantage 2 (HMO-POS) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $9,250.00? |
| Drug deductible | $300.00Tier 1, 2 and 6 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO-POS? |
| Contract / plan | H2593-029-0 |
| Offered by | Wellpoint |
| Parent organization | Elevance Health, Inc. |
| Formulary drugs | 3,554 |
| Formulary exception tier | 4? |
| Pharmacy search | www.myamerigroup.com/medicare |
| Member services | (833)668-1020TTY 711 |
CMS star ratings
- Overall
- 3.5 out of 5 stars for Overall
- Health plan (Part C)
- 3 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H2593 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $30 copay(authorization and referral required) |
| Other health care professional | $0–$20 copay(authorization and referral required) |
| Additional telehealth services | $0 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay(referral required) |
| Glaucoma screening | $0 copay(referral required) |
| Diabetes self-management training | $0 copay(referral required) |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0–$150 copay(authorization and referral required) |
| Lab services | $0–$10 copay(authorization and referral required) |
| Diagnostic radiology (e.g. MRI, CT) | $20–$150 copay(authorization and referral required) |
| Therapeutic radiology | 20% coinsurance(authorization and referral required) |
| Outpatient x-rays | $20 copay(authorization and referral required) |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | $35 copay |
| Worldwide emergency coverage | $115 copay · $100,000 plan limit |
| Worldwide urgent care | $115 copay · $100,000 plan limit |
| Worldwide emergency transportation | $115 copay |
| Hospital care | |
| Inpatient hospital stay | $335 per day for days 1–6; $0 per day for days 7–90(authorization required) |
| Outpatient hospital services | $0–$335 copay(authorization and referral required) |
| Outpatient observation | $335 copay(authorization and referral required) |
| Ambulatory surgical center | $0–$275 copay(authorization and referral required) |
| Outpatient blood services | $0 copay(referral required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $218 per day for days 21–100(authorization required) |
| Home health care | $0 copay(authorization and referral required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | $30 copay(authorization and referral required) |
| Physical therapy and speech-language therapy | $30 copay(authorization and referral required) |
| Cardiac rehabilitation | $30 copay(authorization required) |
| Pulmonary rehabilitation | $15 copay(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $335 per day for days 1–6; $0 per day for days 7–90(authorization required) |
| Outpatient mental health, individual session | $35 copay(authorization and referral required) |
| Outpatient mental health, group session | $35 copay(authorization and referral required) |
| Psychiatrist, individual session | $35 copay(authorization and referral required) |
| Psychiatrist, group session | $35 copay(authorization and referral required) |
| Partial hospitalization | $35 copay(authorization required) |
| Intensive outpatient program | $35 copay(authorization required) |
| Outpatient substance use, individual session | $35 copay(authorization and referral required) |
| Outpatient substance use, group session | $35 copay(authorization and referral required) |
| Opioid treatment program | $35 copay(authorization and referral required) |
| Ambulance and transportation | |
| Ground ambulance | $276 copay(authorization required) |
| Air ambulance | $276 copay(authorization required) |
| Transportation to plan-approved locations | Not covered |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 0%–20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay |
| Diabetic therapeutic shoes or inserts | $0 copay |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $15 copay(authorization and referral required) |
| Routine chiropractic care | Not covered |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $30 copay(authorization and referral required) |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $30 copay(authorization required) |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | Optional supplemental benefit (extra premium) |
| Dental x-rays | Optional supplemental benefit (extra premium) |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Restorative services (fillings, crowns) | Not covered |
| Endodontics (root canals) | Not covered |
| Periodontics (gum disease) | Not covered |
| Dentures and other removable prosthodontics | Not covered |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | Not covered |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0–$30 copay |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | 20% coinsurance(limits apply) |
| Eyewear plan limit | $100 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $30 copay(authorization and referral required) |
| Routine hearing exam | Not covered |
| Hearing aid fitting and evaluation | Not covered |
| Hearing aids (all types) | Not covered |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $35 copay(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $44 allowance every three months |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | Not covered |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $2.00 |
| Tier 3 | 20% |
| Tier 4 | 30% |
| Tier 5 | 29% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $2.00 | $7.00 | $0.00 | $6.00 | $21.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $2.00 | $7.00 | $0.00 | $6.00 | $21.00 | $0.00 |
| Tier 3: Preferred Brand | 20% | 25% | 20% | 20% | 25% | 20% |
| Tier 4: Non-Preferred Drug | 30% | 30% | 30% | 30% | 30% | 30% |
| Tier 5: Specialty Tier | 29% | 29% | 29% | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 82 other TX counties
- Archer
- Atascosa
- Austin
- Bailey
- Bandera
- Bastrop
- Bexar
- Blanco
- Briscoe
- Burnet
- Caldwell
- Castro
- Chambers
- Clay
- Cochran
- Collin
- Colorado
- Comal
- Cooke
- Crosby
- Dallas
- Delta
- Denton
- Dickens
- El Paso
- Floyd
- Fort Bend
- Galveston
- Garza
- Gonzales
- Grayson
- Grimes
- Hale
- Hamilton
- Hardin
- Harris
- Hays
- Henderson
- Hockley
- Hudspeth
- Hunt
- Jack
- Jasper
- Jefferson
- Johnson
- Kendall
- Lamb
- Lampasas
- La Salle
- Lee
- Liberty
- Lubbock
- Lynn
- Mason
- Matagorda
- Medina
- Mills
- Montague
- Montgomery
- Motley
Benefits in plain text
Wellpoint Medicare Advantage 2 (HMO-POS) (H2593-029-0) is a 2026 HMO-POS Medicare Advantage plan offered by Wellpoint, available to residents of Guadalupe County, TX.
The monthly premium is $0.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $9,250.00.
The drug deductible is $300.00. Tier 1, 2 and 6 exempt.
The plan's formulary lists 3,554 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $2.00; tier 3: 20%; tier 4: 30%; tier 5: 29%; tier 6: $0.00.
CMS gives the plan's contract (H2593) an overall rating of 3.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.