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Astiva Health C-SNP WOW - NorCal (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 - NorCal (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 - NorCal (HMO C-SNP) in 2026, please refer to our full plan details page.
Astiva Health C-SNP WOW - NorCal (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: SCL. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Astiva Health C-SNP WOW - NorCal (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 - NorCal (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 - NorCal (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 - NorCal (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 a $615.00 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 $9250.00 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 - NorCal (HMO C-SNP) plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. For individuals who qualify for the low-income subsidy, the Part D premium may be reduced to $12.00. After meeting the deductible, members enter the initial coverage phase where they pay set copays or coinsurance until total drug costs reach $2,100.00. During the initial coverage phase at standard pharmacies, Tier 1 preferred generics cost a $15.00 copay, Tier 2 standard generics cost a $45.00 copay, and Tier 3 preferred brands require a $100.00 copay. Tier 4 non-preferred drugs carry a 25% coinsurance, while Tier 5 specialty drugs have no copay. Once yearly out-of-pocket costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Astiva Health C-SNP WOW - NorCal (HMO C-SNP) plan provides robust medical coverage, featuring no copay for preventive services and urgently needed care. Most outpatient care, diagnostic tests, and dialysis treatments require a 20% coinsurance with no copay, while emergency room visits have a $70 copay. Skilled nursing facility care offers the first 20 days with no copay, whereas inpatient acute care features no cost sharing on the day of discharge. For extra wellness support, the plan offers routine hearing and vision exams with no copay or deductible, plus a $300 eyewear allowance every two years. Dental care is covered with a 20% coinsurance for Medicare-covered services and a $350 quarterly allowance for other dental needs. Members also benefit from no copay on up to 24 one-way health-related transportation trips per year and over-the-counter items with no benefit limit.
Inpatient Hospital See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) partially covers inpatient hospital services, requiring prior authorization and doctor referrals for both acute and psychiatric stays. Inpatient acute care covers unlimited additional days with no cost sharing on the day of discharge, while psychiatric stays require Medicare-defined cost sharing, including an $816 copay for additional days 91 through 150, with no coinsurance details provided. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services under the Astiva Health C-SNP WOW - NorCal (HMO C-SNP) are covered, with most care—including outpatient hospital, observation, ambulatory surgical center, and substance abuse sessions—requiring a 20% coinsurance and no copayment. Prior authorization and doctor referrals are generally required, and outpatient blood services are provided with no deductible.
Partial Hospitalization See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) covers partial hospitalization benefits with an $80.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) covers ambulance services with a $200 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services are partially covered, offering up to 24 one-way trips per year to any health-related location with no copay or coinsurance, while transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) partially covers emergency services, requiring a $70 copay and no coinsurance for emergency room visits, and no copay or coinsurance for urgently needed services. While worldwide emergency and urgent care are covered up to a $50,000 maximum, worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits are covered by Astiva Health C-SNP WOW - NorCal (HMO C-SNP), though podiatry and routine chiropractic services are not covered. Patients pay a 20% coinsurance for physical, occupational, and speech therapies, a $15 copay for opioid treatment, a $45 copay for psychiatric services, and a $50 copay for mental health specialty sessions.
Preventive Services See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) partially covers preventive services with no copay and no coinsurance for Medicare-covered zero-dollar services. Covered options include kidney disease education, memory fitness, and personal emergency response systems, while annual physical exams, health education, in-home safety assessments, and medical nutrition therapy are not covered.
Hearing Services See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) covers hearing exams with no deductible, requiring prior authorization for one routine exam and two fitting evaluations yearly. Hearing services are partially covered, as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered, with a $500 annual limit on covered prescription hearing aids.
Vision Services See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) partially covers vision services with no copay, no coinsurance, and no deductible, though eyewear upgrades are not covered. This plan features one routine eye exam per year and a $300 maximum coverage limit every two years for eyeglasses and contact lenses.
Dental Services See details
Dental services are partially covered by Astiva Health C-SNP WOW - NorCal (HMO C-SNP), which provides Medicare dental services with a 20% coinsurance, no copay, and required referrals and prior authorizations. Other dental services are covered up to $350 every three months, though maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Astiva Health C-SNP WOW - NorCal (HMO C-SNP), requiring prior authorization. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Both prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Medical equipment is covered by Astiva Health C-SNP WOW - NorCal (HMO C-SNP) with no copays and coinsurance ranging from no coinsurance to 20%. Covered items include durable medical equipment, prosthetics, medical supplies, and diabetic equipment, all of which require prior authorization.
Diagnostic and Radiological Services See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) partially covers diagnostic and radiological services, though lab services are not covered. Covered services, such as diagnostic procedures, radiological services, and outpatient X-rays, require prior authorization and a doctor referral, and feature no copay and a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Astiva Health C-SNP WOW - NorCal (HMO C-SNP) plan, but require prior authorization and a doctor referral. Specific copayment and coinsurance details for these services are not specified.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Astiva Health C-SNP WOW - NorCal (HMO C-SNP) plan. Because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage, there are no copay or coinsurance benefits available.
Skilled Nursing Facility (SNF) See details
Astiva Health C-SNP WOW - NorCal (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and a doctor referral. There is no copay or coinsurance for days 1 to 20, and a $218 daily copay with no coinsurance for days 21 to 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Astiva Health C-SNP WOW - NorCal (HMO C-SNP), featuring over-the-counter items with no benefit limit and a chronic illness meal benefit of up to $600 annually with a doctor's referral. Copay and coinsurance details are not specified for these benefits, while acupuncture, nicotine replacement therapy, naloxone, and highly integrated dual-eligible SNP services are not covered.
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