The Health Plan SecureChoice Optimum (PPO) Medicare Advantage Plan H8604-014-2 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7000.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $425.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 5,248 beneficiaries
The Health Plan SecureChoice Optimum (PPO) Introduction
This Medicare Advantage PPO plan, The Health Plan SecureChoice Optimum, is offered by The Health Plan and uses a Preferred Provider Organization (PPO) provider network. It comes with prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $7000.00. The plan is identified by CMS Plan ID H8604-014-2. The 2027 Part D prescription drug deductible is $425.00.
Plan Benefits
The Health Plan SecureChoice Optimum includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H8604-014-2.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $25 copay |
In-network: $0 copay Out-of-network: $25 copay |
| Specialist | In-network: $45 copay Out-of-network: $60 copay |
In-network: $45 copay Out-of-network: $60 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $25 copay |
In-network: $0 copay |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health education | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$250 copay Out-of-network: 30% coinsurance |
In-network: $0-$150 copay Out-of-network: 30% coinsurance |
| Lab services | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Outpatient x-rays | In-network: $95 copay Out-of-network: 30% coinsurance |
In-network: $50 copay Out-of-network: 30% coinsurance |
| Diagnostic tests and procedures | In-network: $50 copay Out-of-network: 30% coinsurance |
In-network: $50 copay Out-of-network: 30% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $130 copay | $125 copay |
| Worldwide emergency care | Coming soon | $125 copay |
| Urgent care | $40 copay | $40 copay |
| Inpatient hospital care | In-network: Tier 1 $395 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
In-network: Tier 1 $375 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 30% per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 Out-of-network: 20% per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 20% per stay |
| Ground ambulance | In-network: $275 copay Out-of-network: $275 copay |
In-network: $250 copay Out-of-network: $250 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $45 copay Out-of-network: $60 copay |
In-network: $45 copay Out-of-network: $60 copay |
| Outpatient group therapy | In-network: $45 copay Out-of-network: $60 copay |
In-network: $45 copay Out-of-network: $60 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $395 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
In-network: Tier 1 $375 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 30% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $40 copay Out-of-network: $60 copay |
In-network: $40 copay Out-of-network: $60 copay |
| Occupational therapy | In-network: $40 copay Out-of-network: $60 copay |
In-network: $40 copay Out-of-network: $60 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $60 copay |
In-network: $0 copay Out-of-network: $60 copay |
| Contact lenses | In-network: $0 copay Out-of-network: $15 copay |
In-network: $0 copay Out-of-network: $15 copay |
| Eyeglass frames only | In-network: $0 copay Out-of-network: $15 copay |
In-network: $0 copay Out-of-network: $15 copay |
| Eyeglass lenses only | In-network: $0 copay Out-of-network: $15 copay |
In-network: $0 copay Out-of-network: $15 copay |
| Eyeglasses (frames & lenses) | Not covered | Not covered |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $60 copay |
In-network: $0 copay Out-of-network: $60 copay |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 80% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Prescription hearing aids | In-network: $399-$899 copay Out-of-network: 80% coinsurance |
In-network: $399-$899 copay Out-of-network: $399-$899 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by The Health Plan SecureChoice Optimum as a Part B benefit.
Prescription Drug Coverage
The Health Plan SecureChoice Optimum includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $12.80 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $425.00 annual Part D deductible. You'll pay this deductible at the pharmacy before The Health Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, The Health Plan SecureChoice Optimum may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $5.00 copay | Coming soon |
| Preferred Brand | 20% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 28% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H8604)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for The Health Plan
- Website
- The Health Plan Plan Page
- Providers
- The Health Plan Providers Page
- Formulary
- The Health Plan Formulary Page
- Pharmacy
- The Health Plan Pharmacy Page
- New Member Health Plan Help
- (877)847-7915
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (877)847-7915
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
The Health Plan SecureChoice Optimum (H8604-014-2) is available in the following locations:
West Virginia Counties Served
- Barbour
- Berkeley
- Boone
- Braxton
- Brooke
- Cabell
- Calhoun
- Clay
- Doddridge
- Fayette
- Gilmer
- Grant
- Greenbrier
- Hampshire
- Hancock
- Hardy
- Harrison
- Jackson
- Jefferson
- Kanawha
- Lewis
- Lincoln
- Logan
- Marion
- Marshall
- Mason
- Mcdowell
- Mercer
- Mineral
- Mingo
- Monongalia
- Monroe
- Morgan
- Nicholas
- Ohio
- Pendleton
- Pleasants
- Pocahontas
- Preston
- Putnam
- Raleigh
- Randolph
- Ritchie
- Roane
- Summers
- Taylor
- Tucker
- Tyler
- Upshur
- Wayne
- Webster
- Wetzel
- Wirt
- Wood
- Wyoming
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About The Health Plan SecureChoice Optimum (PPO)
What is the monthly premium for The Health Plan SecureChoice Optimum (PPO)?
The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H8604-014-2?
For 2027, the in-network maximum out-of-pocket is $7000.00. The plan pays 100% of covered in-network services beyond this amount.
What is the star rating for plan H8604-014-2 in 2027?
For 2027, plan H8604-014-2 has a CMS star rating of ★0.0 out of 5 stars.
What is the total enrollment for plan H8604-014-2?
Total enrollment is 5,248 beneficiaries based on the latest CMS data.
Is there a Part D deductible for this plan?
The Part D deductible is $425.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| The Health Plan (official source) | http://www.healthplan.org/medicare | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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