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Wellpoint I Carelon Home Care 2 (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 2 (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 2 (HMO I-SNP) in 2025, please refer to our full plan details page.
Wellpoint I Carelon Home Care 2 (HMO I-SNP) is a HMO I-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Pima and Maricopa Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellpoint I Carelon Home Care 2 (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 2 (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 2 (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 2 (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 2 (HMO I-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different amounts depending on the drug tier and pharmacy. For example, you'll pay a $7.50 copay at a standard pharmacy for preferred generic drugs, or no copay for preferred generic drugs through mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Wellpoint I Carelon Home Care 2 (HMO I-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $170 copay for days 1-5, and no copay for days 6-90. Outpatient services have a copay between $0 and $125, and emergency services have a $120 copay. This plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, often with no copay. Home health, skilled nursing, and home infusion services also have no copay. The plan offers additional benefits like ambulance and transportation, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $170 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $170 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered Stay for Inpatient Hospital-Acute and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $125, and observation services have a $125 copay, while ambulatory surgical center services, individual sessions for outpatient substance abuse, group sessions for outpatient substance abuse, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $195 copay. Transportation Services to a Plan Approved Health-related Location are covered with no copay, and include up to 6 one-way trips per year, but Transportation Services to any Health-related Location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Wellpoint I Carelon Home Care 2 (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 Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services and Mental Health Specialty Services require prior authorization, and Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other preventive services including Fitness Benefit, Remote Access Technologies, and Kidney Disease Education Services. Additional preventive services like Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams and routine hearing exams have no copay, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids have a maximum benefit of $3,000 per year, and OTC hearing aids have a maximum benefit of $300 per year, both with no copay. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
The Wellpoint I Carelon Home Care 2 (HMO I-SNP) plan covers vision services, including routine eye exams and eyewear, with no copay. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are covered with no copay, while eyeglass frames are covered with no copay. Upgrades are not covered.
Dental Services See details
The Wellpoint I Carelon Home Care 2 (HMO I-SNP) plan covers dental services, including oral exams, dental x-rays, and cleanings, with no copay. This plan has a maximum benefit of $1500 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, the copay is $35. 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 by the Wellpoint I Carelon Home Care 2 (HMO I-SNP) plan, with a coinsurance between 20% and 20%.
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, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have no copay, and lab services have no copay. Diagnostic Radiological Services have a copay of up to $150, while Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Wellpoint I Carelon Home Care 2 (HMO I-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 not covered by the Wellpoint I Carelon Home Care 2 (HMO I-SNP) plan. Specifically, 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint I Carelon Home Care 2 (HMO I-SNP) plan, with no copay for days 1-20 and days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellpoint I Carelon Home Care 2 (HMO I-SNP) plan covers Over-the-Counter (OTC) items with no copay, up to a maximum of $89 every three months. Acupuncture, Meal Benefit, 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.
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