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WellSense Premium Savings (HMO)

New Hampshire Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$0
by WellSense Health Plan

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 2.5
out of 5 stars

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Plan Overview

Plan Name
WellSense Premium Savings (HMO)
Insurance Carrier
WellSense Health Plan
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

WellSense Premium Savings (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in New Hampshire and offered by the health insurance company WellSense Health Plan. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$4,900
Primary doctor visit
$0 copay
Specialist visit
$50 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$295 copay

WellSense Premium Savings (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $4,900 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for WellSense Premium Savings (HMO) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

WellSense Premium Savings (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. WellSense Premium Savings (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. WellSense Premium Savings (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Comparing the Quality Score of WellSense Premium Savings (HMO) to Other Plans in New Hampshire

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, WellSense Premium Savings (HMO) received an overall government quality rating of 2.5 stars out of 5 stars.

WellSense Premium Savings (HMO) performed worse than New Hampshire’s State average overall quality score of 3.4 stars.

This Plan’s 5-star Gov’t Quality Score
New Hampshire State Average Score
Overall Government 5 Star Quality Rating
 2.5
 3.4
Summary rating of health plan quality
 2.5
 3.4
Staying healthy: screenings, tests, & vaccines
 1
 3.4
Managing chronic (long term) conditions
 3
 3.2
Member experience with health plan
 1
 3.1
Member complaints & changes in the health plan's performance
(coming soon)
 4.1
Health plan customer service
(coming soon)
 4.1
Summary rating of drug plan quality
 3.5
 3.7
Drug plan customer service
 4
 4.2
Member complaints & changes in the drug plan's performance
(coming soon)
 4.0
Member experience with the drug plan
(coming soon)
 3.3
Drug safety & accuracy of drug pricing
 4
 3.4

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

WellSense Premium Savings (HMO) received 2.5 stars for its health plan quality score which is worse than the New Hampshire State average health plan quality score of 3.4 stars.

WellSense Premium Savings (HMO) received 3.5 stars for its drug plan quality score which is worse than the New Hampshire State average drug plan quality score of 3.7 stars.

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$4,900 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
http://wellsense.org/medicare
Plan Link
http://wellsense.org/medicare

Medical Benefits

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$50 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0-10 copay
Lab services
$0-10 copay
Diagnostic radiology services (like MRI)
$80-350 copay
Outpatient x-rays
$80 copay
Emergency care
$125 copay per visit (always covered)
Urgent care
$55 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$425 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage
$0-410 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$214 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$295 copay

Therapy services

Occupational therapy visit
$45 copay
Physical therapy & speech & language therapy visit
$65 copay

Mental health services

Outpatient group therapy with a psychiatrist
$60 copay
Outpatient individual therapy with a psychiatrist
$60 copay
Outpatient group therapy visit
$60 copay
Outpatient individual therapy visit
$60 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
0-20% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$0.00 copay$0 copay
Generic$10.00 copay$0 copay
Preferred Brand$47.00 copay$0 copay
Non-Preferred Drug$100.00 copay$0 copay
Specialty Tier29% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Extra Benefits

Hearing

Hearing exam
$50 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$699-999 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Endodontics
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Periodontics
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, removable
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, fixed
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Orthodontics
Not covered
Adjunctive general services
In-network: 50% coinsurance
Out-of-network: 50% coinsurance

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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