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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 2025, 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 Pima County. This plan received an overall rating of 3 out of 5 stars in 2025.
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 has an enhanced alternative drug benefit with no deductible. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $7.50 copay at preferred pharmacies and $12.50 at standard pharmacies, while standard mail order has no copay. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. Note that for those who qualify for the low-income subsidy, the plan's premium will be reduced.
Additional Benefits
The Wellpoint Lung Care (HMO-POS C-SNP) plan offers a range of benefits with varying cost-sharing. For hospital stays, you'll pay a $200 copay for days 1-5, with no copay for the remainder of the stay. Outpatient services, primary care, preventive services, and many other services have no copay. This plan also includes coverage for ambulance and transportation services, emergency services, hearing, vision, and dental services. Additional benefits include home infusion, dialysis, medical equipment, and diagnostic services with varying copays or coinsurance. Other services such as over-the-counter items and a meal benefit are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For days 1-5, the copay is $200, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute and Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $175, Observation Services with a $175 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a $30 copay, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Lung Care (HMO-POS C-SNP) plan and requires prior authorization. You will pay a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance. Ground and air ambulance services have a $195 copay, while transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay, Urgently Needed Services have a $15 copay, and Worldwide Emergency Services have a $120 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Wellpoint Lung Care (HMO-POS C-SNP) plan covers primary care physician services, with no copay. Chiropractic services have a $20 copay, but routine care is not covered. Occupational therapy services have a $15 copay, and physical therapy and speech-language pathology services have a copay between $0 and $15.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, Annual Physical Exams with no copay, and additional preventive services with a copay for Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications. Additional services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The Wellpoint Lung Care (HMO-POS C-SNP) plan covers hearing exams and routine hearing exams with no copay, as well as fitting/evaluation for hearing aids with no copay. This plan also covers prescription hearing aids, with a maximum plan benefit of $1500 per year, and OTC hearing aids with no copay, up to $300 per year.
Vision Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay, a combined maximum plan benefit coverage of $225 every year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are unlimited.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics; some services require prior authorization and have a copay of $0.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0% to 20%, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Prosthetic Devices have a coinsurance of 0% to 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services with no copay for diagnostic procedures/tests and no copay for lab services. Diagnostic radiological services have a maximum copay of $150, while therapeutic radiological services have a coinsurance of at most 20%, and outpatient X-ray services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $75.
Other Services See details
Under "Other Services", acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-Counter (OTC) Items and Meal Benefit are covered with no copay, while the OTC items have a maximum plan benefit of $105.00 every three months. Medicare Community Resource Support and Other 1 are covered with no copay.
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