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Wellpoint Chronic Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Chronic 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 Chronic Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Wellpoint Chronic 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 Chronic 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 Chronic 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 Chronic 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 Chronic 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 Chronic Care (HMO-POS C-SNP) plan has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay a $4 copay for preferred generic drugs at a preferred pharmacy, and a $0 copay for preferred generic drugs through standard mail. For other tiers, you will pay coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Wellpoint Chronic Care (HMO-POS C-SNP) plan offers comprehensive coverage with a variety of benefits. This plan includes inpatient hospital stays with a $200 copay for the first 5 days and no copay for the remainder, outpatient services with varying copays, and emergency services with a $120 copay. Additional benefits include no copay for primary care, preventive services, hearing exams, eyewear, and many dental services. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services with varying cost-sharing. There are also additional benefits such as an OTC allowance, a meal benefit, and transportation services, all with varying copays.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, 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. However, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric 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, Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for many services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Chronic Care (HMO-POS C-SNP) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $195 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, up to 72 one-way trips per year; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay, and Urgently Needed Services have a $15 copay. Worldwide Emergency Services has a $120 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, and Additional Telehealth Benefits have no copay. Chiropractic Services have a $20 copay, while Occupational Therapy Services have a $15 copay. Mental Health, Podiatry, Other Health Care Professional, Psychiatric, and Physical Therapy services have varying copays, and Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services, with annual physical exams offered with no copay. The plan also covers a Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices, with a copay of $0.00. Additionally, the plan covers Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
The Wellpoint Chronic Care (HMO-POS C-SNP) plan covers hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and OTC hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
The Wellpoint Chronic Care (HMO-POS C-SNP) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with a $0 copay. Eyewear has a combined maximum benefit of $225 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Other dental services are covered with a $500 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Chronic Care (HMO-POS C-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance of 0-20%, while Prosthetics/Medical Supplies and Diabetic Equipment have no copay and a coinsurance of 0-20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, and Radiological Services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $150, and Therapeutic Radiological Services have coinsurance of at most 20%. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Wellpoint Chronic Care (HMO-POS C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some cardiac and pulmonary rehabilitation services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Wellpoint Chronic 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. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Wellpoint Chronic Care (HMO-POS C-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $105 every three months. The plan does not cover Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, or Self-Directed Personal Assistance Services. The plan also covers a Meal Benefit with no copay, but requires prior authorization.
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