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Wellpoint Lung Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Lung Care (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Lung Care (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Wellpoint Lung Care (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in Arizona. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellpoint Lung Care (HMO-POS C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellpoint Lung Care (HMO-POS C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellpoint Lung Care (HMO-POS C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellpoint Lung Care (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2700.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Wellpoint Lung Care (HMO-POS C-SNP) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, members pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or standard mail, compared to a $10 copay at standard pharmacies. Tier 2 standard generic drugs require a 20% coinsurance at preferred pharmacies and standard mail, or a 25% coinsurance at standard pharmacies. For higher tiers, Tier 3 preferred brands require a 30% coinsurance and Tier 4 non-preferred drugs require a 33% coinsurance, while Tier 5 specialty drugs feature no copay. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Qualifying for the low-income subsidy can also reduce your Part D premium to $0.
Additional Benefits
The Wellpoint Lung Care (HMO-POS C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth, and home health services. Inpatient hospital stays require a $200 daily copay for the first five days and no copay thereafter, while emergency services carry a $150 copay that is waived upon admission. Outpatient services, specialist visits, and diagnostic tests generally feature low to no copays, though some services may require coinsurance up to 20 percent. This plan also includes valuable everyday benefits, offering routine dental, vision, and hearing care with no copay up to generous annual limits. Members can access up to 72 one-way trips to plan-approved locations for medical transportation and receive select over-the-counter items with no copay. However, certain services like cardiac rehabilitation are not covered under this plan.
Inpatient Hospital See details
Wellpoint Lung Care (HMO-POS C-SNP) partially covers inpatient hospital benefits with a $200 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance for acute and psychiatric stays. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a $0 to $175 copay, observation services have a $175 copay per stay, and outpatient substance abuse sessions cost a $35 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Wellpoint Lung Care (HMO-POS C-SNP) plan with a $30 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers ground and air ambulance services with a $195 copay and no coinsurance. Transportation services are partially covered, offering up to 72 one-way trips to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Wellpoint Lung Care (HMO-POS C-SNP) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 lifetime limit with a $150 copay.
Primary Care See details
Wellpoint Lung Care (HMO-POS C-SNP) covers primary care physician visits and telehealth benefits with no copay and no coinsurance. Specialist visits, physical therapy, and mental health services require copays ranging from $0 to $35 with no coinsurance, though chiropractic services are only partially covered because routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Wellpoint Lung Care (HMO-POS C-SNP) with no copay and no coinsurance for covered benefits like annual physicals, diabetes self-management training, and home safety devices. However, several sub-services are not covered, including health education, weight management, personal emergency response systems, and in-home support services.
Hearing Services See details
Wellpoint Lung Care (HMO-POS C-SNP) partially covers hearing services with no copay or coinsurance for routine exams, fitting evaluations, OTC hearing aids, and select prescription hearing aids. While OTC hearing aids are covered up to $300 annually and prescription aids up to $2,000 annually, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services are partially covered by Wellpoint Lung Care (HMO-POS C-SNP) with no deductibles or coinsurance. Routine eye exams and eyewear, including contact lenses and eyeglasses, feature no copay up to a $250 annual limit, other eye exams have a copay of $0 to $30, and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Wellpoint Lung Care (HMO-POS C-SNP) up to a $1,500 annual maximum, excluding maxillofacial prosthetics, implant services, and orthodontics. Covered preventive and comprehensive services require no copay and no coinsurance, while Medicare-covered dental services have a copay of $0 to $30 and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellpoint Lung Care (HMO-POS C-SNP) with prior authorization, offering Medicare Part B insulin at a $35 copay and no coinsurance. Other Part B chemotherapy, radiation, and miscellaneous drugs require no copay and feature coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers dialysis services with no copay, though coinsurance information is not specified. This benefit helps Medicare beneficiaries access essential kidney treatments while keeping out-of-pocket copayment costs at zero.
Medical Equipment See details
Medical Equipment benefits are covered by Wellpoint Lung Care (HMO-POS C-SNP) with prior authorization required. Durable medical equipment, prosthetics, and medical supplies feature no copay and a 0% to 20% coinsurance, while diabetic supplies and therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellpoint Lung Care (HMO-POS C-SNP) with prior authorization, featuring no copay and no coinsurance for diagnostic tests, procedures, and lab services. Outpatient X-rays require a $15 copay and no coinsurance, diagnostic radiological services have a $0 to $150 copay and no coinsurance, and therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellpoint Lung Care (HMO-POS C-SNP) plan, as all associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Wellpoint Lung Care (HMO-POS C-SNP) partially covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization. Under this benefit, there is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellpoint Lung Care (HMO-POS C-SNP) provides coverage for select other services, including over-the-counter items, chronic illness meals, and community resource support, with no copays or coinsurance. However, acupuncture and highly integrated services for dual eligible SNPs are not covered.
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