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Wellpoint I Carelon Home Care (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint I Carelon Home Care (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint I Carelon Home Care (HMO I-SNP) in 2025, please refer to our full plan details page.
Wellpoint I Carelon Home Care (HMO I-SNP) is a HMO I-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Maricopa County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellpoint I Carelon Home Care (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellpoint I Carelon Home Care (HMO I-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 I Carelon Home Care (HMO I-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 I Carelon Home Care (HMO I-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 I Carelon Home Care (HMO I-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying costs depending on the drug tier and pharmacy. For example, in the standard pharmacy, you will pay a $7.50 copay for preferred generic drugs, 25% coinsurance for standard generic and preferred brand drugs, and 33% coinsurance for non-preferred drugs. In the preferred mail order pharmacy, you will pay no copay for preferred generic drugs and 25% coinsurance for standard generic and preferred brand drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellpoint I Carelon Home Care (HMO I-SNP) plan offers comprehensive coverage with a focus on home health and other services, often with no copay. This plan provides coverage for a wide range of services including primary care, preventive services, hearing, vision, and dental services, all with no copays for many of these services. Additionally, the plan includes coverage for outpatient services, ambulance, emergency services, and home health services, with varying copays and coinsurance amounts depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-5, there is a $175 copay, and for days 6-90, there is no copay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays 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 no copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint I Carelon Home Care (HMO I-SNP) plan. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services with a $250 copay, and transportation services with no copay, including 12 one-way trips per year to a plan-approved health-related location via rideshare services, bus/subway, van, or medical transport. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Wellpoint I Carelon Home Care (HMO I-SNP) plan. Emergency Services have a $120 copay, while Urgently Needed Services have no copay; Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay.
Primary Care See details
Primary Care benefits with the Wellpoint I Carelon Home Care (HMO I-SNP) plan cover primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services have no copay. Chiropractic services and routine chiropractic care are covered with a $0 copay. Occupational therapy services and physical therapy and speech-language pathology services have no coinsurance and a $0 copay. Physician specialist services have no copay. Individual and group mental health specialty sessions have no copay. Podiatry services and routine foot care have no copay. Other health care professional services have a maximum copay of $20. Individual and group psychiatric sessions have no copay. Additional telehealth benefits have no copay. Opioid treatment program services have no copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services and kidney disease education services are covered; however, other services such as health education and counseling services are not covered. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay.
Hearing Services See details
The Wellpoint I Carelon Home Care (HMO I-SNP) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $3,000 per year, and OTC hearing aids are covered with no copay, up to $300 per year.
Vision Services See details
Vision services include eye exams and eyewear, with no copay. Eyewear has a combined maximum benefit of $275 per year, and upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay. This plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery, each with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint I Carelon Home Care (HMO I-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetics/Medical Supplies with a coinsurance of 0% to 20%, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. 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, diagnostic procedures/tests, and lab services with no copay. Diagnostic Radiological Services have a copay of at most $150, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered 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 plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required, and copay information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint I Carelon Home Care (HMO I-SNP) plan, with no copay for days 1-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Other 1, with no copay, but acupuncture, meal benefits, 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, and Self-Directed Personal Assistance Services are not covered. OTC items have a maximum benefit coverage of $200 every three months.
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