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Astiva Health C-SNP WOW (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Astiva Health C-SNP WOW (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Astiva Health C-SNP WOW (HMO C-SNP) in 2025, please refer to our full plan details page.
Astiva Health C-SNP WOW (HMO C-SNP) is a HMO C-SNP plan offered by Astiva Health Holdings Incorporated available for enrollment in 2025 to people living in Counties: OC, LA, RIV, SB, SD. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Astiva Health C-SNP WOW (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Astiva Health C-SNP WOW (HMO 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 Astiva Health C-SNP WOW (HMO 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 Astiva Health C-SNP WOW (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.70. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 Astiva Health C-SNP WOW (HMO C-SNP) plan has an enhanced alternative drug benefit. The deductible for prescription drugs is $590. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy used. In the initial coverage phase, you will pay a copay of $15 for preferred generic drugs at a standard or mail-order pharmacy, $35 for standard generic drugs, and $95 for preferred brand drugs. Non-preferred drugs have a 25% coinsurance, while specialty tier drugs have no copay. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Astiva Health C-SNP WOW (HMO C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance amounts. Emergency, primary care, preventive, and home health services are covered with no copay, but some services require prior authorization or doctor referrals. The plan also provides coverage for hearing, vision, and dental services, with specific limitations on coverage for hearing aids, eyewear, and dental procedures. Additional benefits include coverage for ambulance and transportation services, partial hospitalization, dialysis services, home infusion, and medical equipment. Other services include acupuncture, an over-the-counter (OTC) item benefit, and a meal benefit. However, some services are not covered, such as certain types of hearing aids, dental procedures, and various home-based and personal care services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with services not usually covered by Medicare plans, but require prior authorization and a doctor referral. For additional days (91-150) in either Inpatient Hospital-Acute or Inpatient Hospital Psychiatric, there is a copay of $816. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, are covered with a 20% coinsurance. Individual and group sessions for outpatient substance abuse are covered with a $20 copay, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $80 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $200 copay and air ambulance services with 20% coinsurance. Transportation Services are partially covered, with coverage for any health-related location, but not for plan-approved health-related locations.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the Astiva Health C-SNP WOW (HMO C-SNP) plan. Emergency Services has a copay of $110, and no coinsurance, and Worldwide Emergency Services has a maximum plan benefit coverage of $50,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Astiva Health C-SNP WOW (HMO C-SNP) plan covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services and physical therapy services require prior authorization and a doctor's referral with a 20% coinsurance. Individual and group sessions for mental health and psychiatric services have a $25 copay. Opioid treatment program services have a $15 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Astiva Health C-SNP WOW (HMO C-SNP) plan covers preventive services, including Medicare-covered services with no copay, and additional preventive services like alternative therapies, therapeutic massage, and fitness benefit. The plan does not cover annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is covered for two visits per year. Prescription hearing aids are covered up to $750 per year, and prescription hearing aids (all types) are covered for two visits per year. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Astiva Health C-SNP WOW (HMO C-SNP) plan covers vision services including routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year, and contact lenses are covered for one pair every two years. Eyewear has a combined maximum benefit of $300 every two years.
Dental Services See details
The Astiva Health C-SNP WOW (HMO C-SNP) plan covers Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $400 every three months. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered, with limitations on the number of visits allowed per year. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Implant Services, Prosthodontics (fixed), and Oral and Maxillofacial Surgery are also covered. However, Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Astiva Health C-SNP WOW (HMO C-SNP) plan, requiring prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Astiva Health C-SNP WOW (HMO C-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Prosthetic Devices, Medicare-covered Medical Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Diabetic Supplies have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Astiva Health C-SNP WOW (HMO C-SNP) plan with no copay and no coinsurance, but require prior authorization and a referral. 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 Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Astiva Health C-SNP WOW (HMO C-SNP) plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-20, and a $214 copay for days 21-100; there is no coinsurance.
Other Services See details
Other services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture is covered for up to 80 treatments per year, and OTC items are covered, but the plan does not cover Nicotine Replacement Therapy (NRT) or Naloxone. The plan also covers a meal benefit up to $600 per year with a doctor's referral. The following services are not covered: 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.
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