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Wellpoint Lung Care 2 (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Lung Care 2 (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 Lung Care 2 (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Wellpoint Lung Care 2 (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 3.5 out of 5 stars in 2025.
It's important to know that Wellpoint Lung Care 2 (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 Lung Care 2 (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 Lung Care 2 (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 Lung Care 2 (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 $8300.00 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 Lung Care 2 (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $7.50 copay at a preferred pharmacy for Tier 1 drugs, and 20% coinsurance for Tier 2 drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. This plan may have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Wellpoint Lung Care 2 (HMO-POS C-SNP) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay for the first few days, but no copay for the majority of the stay. The plan also covers outpatient services, with copays ranging from $0 to $175 depending on the service. This plan provides coverage for primary care, mental health, vision, and dental services, often with no copay. Additional benefits include hearing services, ambulance services, and transportation services, with specific copays. The plan also covers home health services, medical equipment, and diagnostic services, and has a maximum annual benefit for certain dental services.
Inpatient Hospital See details
Inpatient Hospital benefits include acute and psychiatric care, with a copay of $265 for days 1-6 and no copay for days 7-90. Additional days are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Wellpoint Lung Care 2 (HMO-POS C-SNP) plan, with copays ranging from $0 to $175 depending on the service. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and the plan also covers Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Lung Care 2 (HMO-POS C-SNP) plan, with a $30 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Lung Care 2 (HMO-POS C-SNP) plan, with a $195 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered for 12 one-way trips per year with no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay, and Urgently Needed Services have a $15 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay.
Primary Care See details
The Wellpoint Lung Care 2 (HMO-POS C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $15 copay, and physician specialist services with a copay between $0 and $35. The plan also covers mental health specialty services with a copay between $0 and $25 for individual sessions, and $0 and $25 for group sessions, podiatry services with a copay between $0 and $35, and other health care professional services with a copay between $0 and $20. Physical therapy and speech-language pathology services have a copay between $0 and $15, while additional telehealth benefits have no copay, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered, and some have a copay.
Hearing Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $1500 per year, and OTC hearing aids are covered with no copay up to a maximum of $300 per year. 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 Lung Care 2 (HMO-POS C-SNP) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay and a combined maximum of $175 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are covered with no copay, while upgrades are not covered.
Dental Services See details
The Wellpoint Lung Care 2 (HMO-POS C-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay. The plan has a maximum benefit of $750 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellpoint Lung Care 2 (HMO-POS C-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while 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 Lung Care 2 (HMO-POS C-SNP) plan. There is no copay or coinsurance for dialysis services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a coinsurance between 0% and 20%, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $195, while Therapeutic Radiological Services have a 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 Lung Care 2 (HMO-POS C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with 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
Under the "Other Services" benefit, acupuncture, 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, 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, Self-Directed Personal Assistance Services are not covered. Over-the-counter (OTC) items and a meal benefit are covered with no copay. Medicare Community Resource Support is covered with no copay.
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