Your Benefits

The benefit information provided below does not list every service we cover or list every limitation or exclusion. To get a complete list of services we cover, refer to the appropriate Summary of Benefits and Evidence of Coverage documents found here.

Low premiums, deductibles and out-of-pocket maximums

WellSense offers Medicare Advantage plans with monthly premiums as low as $0/month.

  WellSense Added Value (HMO) WellSense Choice (HMO)  WellSense Signature (HMO)
Monthly Plan Premium $31.10 per month
(Your premium could be less if you qualify for Extra Help.)		 $19 per month $0 per month
Deductible Medicare Part B deductible ($226 in 2023) $0 $0
Maximum Out-of-Pocket $8,300 $5,500 $4,900

 

Over-the-counter (OTC) card

Your plan provides an OTC card with funds added each quarter (in January, April, July, and October) to buy approved everyday items throughout the year at stores across New Hampshire. Use your OTC card to buy select first aid supplies, dental care supplies, fiber supplements, vitamins and more at CVS, Dollar General, Family Dollar, Rite Aid, Stop & Shop, Walgreens and Walmart, or place orders online.

  WellSense Added Value (HMO) WellSense Choice (HMO)  WellSense Signature (HMO)
Over-the-Counter (OTC) items
View items available to purchase with your OTC card		 $150 per quarter $70 per quarter $50 per quarter

 

Preventive care

Coverage is provided for many preventive services, including annual wellness visits, breast cancer screening, cardiovascular disease testing, cancer screenings, depression screening, diabetes screening, immunizations, tobacco use cessation counseling and more. There is no coinsurance, copayment or deductible applied to these benefits by the Plan.

Dental, vision and hearing

Dental health, vision and hearing are all vital to your overall health. Your plan is designed to provide the benefits you need to ensure you stay healthy.

  WellSense Added Value (HMO) WellSense Choice (HMO)  WellSense Signature (HMO)
Dental
  • 2 exams per year
  • 2 cleanings per year
  • X-rays
  • Comprehensive coverage up to $1,5001 per year
  • 2 exams per year
  • 2 cleanings per year
  • X-rays
  • Comprehensive coverage up to $1,7501 per year
  • 2 exams per year
  • 2 cleanings per year
  • X-rays
  • Comprehensive coverage up to $1,2501 per year
Vision
  • Routine vision exam: $0 copay
  • Medicare-covered eyewear: $0 copay
  • $200 allowance toward eyeglasses, contact lenses or hardware upgrades
  • Routine vision exam: $0 copay
  • Medicare-covered eyewear: $0 copay
  • $150 allowance toward eyeglasses, contact lenses or hardware upgrades
  • Routine vision exam: $0 copay
  • Medicare-covered eyewear: $0 copay
  • $150 allowance toward eyeglasses, contact lenses or hardware upgrades
Hearing
  • Routine hearing exam: $0 copay
  • 2 hearing aids per year, up to $1,998
  • Routine hearing exam: $0 copay
  • 2 hearing aids per year, up to $1,998
  • Routine hearing exam: $0 copay

1 Comprehensive Dental Care includes extractions, restorative care, endodontic care, periodontic care, crowns (limitations apply), dentures, surgical procedures related to full and partial dentures, and diagnostic care. Review the Evidence of Coverage for additional benefit information.

Fitness benefits

SilverSneakers® is a complete health and fitness program designed for Medicare beneficiaries at all fitness levels. Members will have access to participating gyms and fitness centers to help them meet their personal wellness goals. There is no coinsurance, copayment or deductible applied to this benefit. 

Home meal benefit

Following a surgery or hospitalization, your plan will provide meals to help you get well. Meals are ordered directly through WellSense and are based on your taste and your diet. You can get up to 14 meals delivered directly to your home.

Home health care

There is no coinsurance, copayment or deductible applied to this benefit. Prior authorization is required.

 

WellSense Medicare Advantage HMO not only provides you access to the doctors and hospitals in New Hampshire you want and the prescription drug coverage you need, it keeps your costs low while providing much more than that.

With our plan, you have an over-the-counter allowance, fitness reimbursements, dental benefits, vision coverage, hearing coverage, meals, transportation and much more!

A $500 over-the-counter (OTC) card

Your WellSense Medicare Advantage HMO plan provides an OTC card with $125 added each quarter (in January, April, July, and October) to buy approved everyday items throughout the year at stores across New Hampshire. That is up to $500 per year to buy select first aid supplies, dental care supplies, fiber supplements, vitamins and much more! Use your OTC card at CVS, Dollar General, Family Dollar, Rite Aid, Stop & Shop, Walgreens and Walmart, or place orders online.

View items available to
purchase with your OTC card

Personal emergency response system

Members receive a personal emergency response system to keep with them at all times. This allows a member to simply press a button to activate their phone and connect them with an emergency dispatcher who will send help.

Dental, vision and hearing

Dental health, vision and hearing are all vital to your overall health. The WellSense Medicare Advantage HMO plan is designed to provide the benefits you need to ensure you stay healthy.

Dental
  • 2 exams per year
  • 2 cleanings per year
  • X-rays
  • Comprehensive coverage up to $7501 per year

Vision
  • 1 exam every 2 years
  • $200 toward eyewear every 2 years

Hearing
  • $1,000 toward hearing aids per year

1 Comprehensive dental includes non-routine services, diagnostic services, restorative services, endodontics, periodontics, extractions and other services. Review the Evidence of Coverage for additional benefit information.

Transportation

Need a ride to your doctor’s appointments? WellSense can help with that. Each year, our members can receive 24 one-way trips to their appointments at no cost. WellSense can also reimburse members for mileage if their family or friends drive them to appointments. Learn more about this benefit.

Fitness reimbursement

WellSense wants to help members live their best lives. Fitness is a big part of that and the WellSense Medicare Advantage HMO plan provides a fitness reimbursement for your fitness club membership or fitness tracker purchase. You can be reimbursed for up to $100 per calendar year for items such as:

• Membership in a health club or YMCA
• Exercise classes such as water aerobics, yoga, pilates or home exercise programs
• Fitness tracker such as a smart watch or pedometer that is wearable and tracks your health and activity levels
Once you are a member, fitness reimbursement forms are available here.

Home meal benefit

Following a surgery or hospitalization, the WellSense Medicare Advantage HMO plan provides meals to members to help them get well. Meals are ordered directly through WellSense and are based on your taste and your diet. You can get up to 14 meals for each discharge from the hospital and up to 28 meals when diagnosed with a chronic condition.

WellSense Medicare Advantage HMO not only provides you access to the doctors and hospitals in New Hampshire you want and the prescription drug coverage you need, it keeps your costs low while providing much more than that.

With our plan, you have an over-the-counter allowance, fitness reimbursements, dental benefits, vision coverage, hearing coverage, meals, transportation and much more!

A $500 over-the-counter (OTC) card

Your WellSense Medicare Advantage HMO plan provides an OTC card with $125 added each quarter (in January, April, July, and October) to buy approved everyday items throughout the year at stores across New Hampshire. That is up to $500 per year to buy select first aid supplies, dental care supplies, fiber supplements, vitamins and much more! Use your OTC card at CVS, Dollar General, Family Dollar, Rite Aid, Stop & Shop, Walgreens and Walmart, or place orders online.

Personal emergency response system

Members receive a personal emergency response system to keep with them at all times. This allows a member to simply press a button to activate their phone and connect them with an emergency dispatcher who will send help.

Dental, vision and hearing

Dental health, vision and hearing are all vital to your overall health. The WellSense Medicare Advantage HMO plan is designed to provide the benefits you need to ensure you stay healthy.

Dental
  • 2 exams per year
  • 2 cleanings per year
  • X-rays
  • Comprehensive coverage up to $7501 per year

Vision
  • 1 exam every 2 years
  • $200 toward eyewear every 2 years

Hearing
  • $1,000 toward hearing aids per year
1 Comprehensive dental includes non-routine services, diagnostic services, restorative services, endodontics, periodontics, extractions and other services. Review the Evidence of Coverage for additional benefit information.

Transportation

Need a ride to your doctor’s appointments? WellSense can help with that. Each year, our members can receive 24 one-way trips to their appointments at no cost. WellSense can also reimburse members for mileage if their family or friends drive them to appointments.

Fitness reimbursement

WellSense wants to help members live their best lives. Fitness is a big part of that and the WellSense Medicare Advantage HMO plan provides a fitness reimbursement for your fitness club membership or fitness tracker purchase. You can be reimbursed for up to $100 per calendar year for items such as:

• Membership in a health club or YMCA
• Exercise classes such as water aerobics, yoga, pilates or home exercise programs
• Fitness tracker such as a smart watch or pedometer that is wearable and tracks your health and activity levels
Once you are a member, fitness reimbursement forms are available here.

Home meal benefit

Following a surgery or hospitalization, the WellSense Medicare Advantage HMO plan provides meals to members to help them get well. Meals are ordered directly through WellSense and are based on your taste and your diet. You can get up to 14 meals for each discharge from the hospital and up to 28 meals when diagnosed with a chronic condition.