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Wellpoint Medicare Advantage (HMO-POS) Medicare Advantage Plan H1212-003 • 2027 • Wirt County, WV

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$9250.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $325.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Wirt County, WV
Local Enrollment
0 beneficiaries in Wirt County
Last update:

Wellpoint Medicare Advantage (HMO-POS) Introduction

This Medicare Advantage HMO-POS plan, Wellpoint Medicare Advantage, is offered by Wellpoint and uses a Health Maintenance Organization with a Point of Service (HMO-POS) 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 $9250.00. The plan is identified by CMS Plan ID H1212-003. The 2027 Part D prescription drug deductible is $325.00.

Enrollment in this plan requires residence in Wirt County, West Virginia. CMS enrollment data reports 0 plan members in Wirt County. New members can call the plan directly at (833)668-2408 (TTY 711) for assistance.

Compare Similar Plans in Wirt County

Compare this plan with the two most-enrolled HMO-POS plans available in Wirt County, West Virginia. Enrollment is based on CMS local enrollment data.

HMO-POS plan comparison for Wirt County, West Virginia
Plan Detail Wellpoint Medicare Advantage Humana Gold Plus H5619-113 AARP Medicare Advantage from UHC WV-6
CMS Plan ID H1212-003-0 H5619-113-0 H4604-034-0
Local Enrollment 0 31 0
Monthly Premium $0.00 $0.00 $0.00
Medical Deductible $0.00 $0.00 $0.00
Maximum Out-of-Pocket $9,250.00 $8,100.00 $8,500.00
Part B Giveback Not offered Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist $45 copay $40 copay $0-$55 copay
Part D Deductible $325.00 $350.00 $685.00
CMS Star Rating Not yet rated Not yet rated Not yet rated
Dental $0 copay $0 copay $0 copay
Vision Not covered $0 copay $0 copay
Hearing Not covered $0 copay $0 copay

Plan Benefits

Wellpoint Medicare Advantage 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 H1212-003.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H1212-003-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $45 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Telehealth benefit
In-network: $0 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
Not covered
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $45-$395 copay
Lab services
In-network: $0 copay
Outpatient x-rays
In-network: $45-$100 copay
Diagnostic tests and procedures
In-network: $0-$100 copay

Emergency and Urgent Care Services

Emergency room care
$115 copay
Worldwide emergency care
Coming soon
Urgent care
$40 copay
Inpatient hospital care
In-network:
Tier 1
$395 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Skilled Nursing Facility
In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Ground ambulance
In-network: $325 copay

Mental Health Services

Outpatient individual therapy
In-network: $45 copay
Outpatient group therapy
In-network: $45 copay
Inpatient psychiatric hospital care
In-network:
Tier 1
$395 per day for days 1-5
$0 per day for days 6-90
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $35 copay
Occupational therapy
In-network: $35 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Durable medical equipment
In-network: 20% coinsurance
Prosthetics
In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Out-of-network: 20%-50% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: 20%-50% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 20%-50% coinsurance
Periodontics
In-network: 25% coinsurance
Out-of-network: 20%-50% coinsurance
Endodontics
In-network: 25% coinsurance
Out-of-network: 20%-50% coinsurance
Restorative services
In-network: 25% coinsurance
Out-of-network: 20%-50% coinsurance
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: 25% coinsurance
Out-of-network: 20%-50% coinsurance

Vision Services

Routine eye exam
Not covered
Contact lenses
Not covered
Eyeglass frames only
Not covered
Eyeglass lenses only
Not covered
Eyeglasses (frames & lenses)
Not covered
Upgrades
Not covered

Hearing Services

Hearing exam
Not covered
Fitting/evaluation
Not covered
Prescription hearing aids
Not covered
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Wellpoint Medicare Advantage as a Part B benefit.

Prescription Drug Coverage

Wellpoint Medicare Advantage 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.

Wellpoint Medicare Advantage (H1212-003-0) Prescription Drug Plan Premium Details
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 $325.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Wellpoint starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Wellpoint Medicare Advantage may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Wellpoint Medicare Advantage (H1212-003-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copayComing soon
Generic$0.00 copayComing soon
Preferred Brand25% coinsuranceComing soon
Non-Preferred Drug27% coinsuranceComing soon
Specialty Tier29% coinsuranceComing soon
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H1212)

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.

2027 Medicare Star Ratings for Contract H1212
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Plan too new to be measured
Managing Chronic (Long Term) Conditions Plan too new to be measured
Member Experience with Health Plan Plan too new to be measured
Complaints and Changes in Plans Performance Plan too new to be measured
Health Plan Customer Service Plan too new to be measured
Drug Plan Customer Service Plan too new to be measured
Complaints and Changes in the Drug Plan Plan too new to be measured
Member Experience with the Drug Plan Plan too new to be measured
Drug Safety and Accuracy of Drug Pricing Plan too new to be measured
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Wellpoint (official source) https://shop.wellpoint.com/med 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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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.