A non-government entity
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 2026, 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 2026.
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:
Sign up for Wellpoint Lung Care 2 (HMO-POS C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellpoint Lung Care 2 (HMO-POS C-SNP) plan offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will pay no copay for tier one preferred generic drugs at preferred pharmacies and standard mail-order services, while standard pharmacies charge a $10 copay. Additionally, tier five specialty drugs feature no copay across all network pharmacy options. For mid-tier medications, standard generics carry a 15% to 20% coinsurance, while preferred brands and non-preferred drugs require 30% and 33% coinsurance respectively. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions.
Additional Benefits
The Wellpoint Lung Care 2 (HMO-POS C-SNP) plan offers comprehensive coverage with no copay and no coinsurance for primary care doctor visits, preventive services, dialysis, and home health care. For inpatient hospital stays, members pay a $265 daily copay for days 1 through 6, followed by no copay and no coinsurance for days 7 through 90. Specialist visits and outpatient services feature low out-of-pocket costs, with specialist copays ranging from no copay to $35 and emergency services requiring a $115 copay. This plan also includes valuable extra benefits, such as dental care up to a $1,000 annual limit and eyewear coverage up to $175, both featuring no copays or coinsurance. Additionally, members can access routine hearing exams, hearing aid coverage, and up to 12 one-way transportation trips per year to approved health locations at no cost. While cardiac rehabilitation is not covered, the plan provides a $42 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers inpatient acute and psychiatric hospital stays with a $265 daily copay for days 1 through 6, no copay for days 7 through 90, and no coinsurance. This benefit is partially covered as upgrades and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $25 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay of $0 to $175, while observation services carry a $175 copay per stay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellpoint Lung Care 2 (HMO-POS C-SNP) with a $30 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers ground and air ambulance services with a $195 copay and no coinsurance. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers emergency services with a $115 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $100,000 with a $115 copay and no coinsurance.
Primary Care See details
Primary Care benefits are covered by Wellpoint Lung Care 2 (HMO-POS C-SNP) with no coinsurance, featuring no copay for primary care physician and telehealth visits, and copays ranging from $0 to $35 for specialist, therapy, and psychiatric services. Chiropractic services are partially covered with a $15 copay, as routine chiropractic care is not covered.
Preventive Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers preventive services with no copay and no coinsurance for services like annual physical exams, kidney disease education, memory fitness, and remote access technologies. This benefit is partially covered, as several sub-services, including health education, weight management programs, and in-home safety assessments, are not covered.
Hearing Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers routine hearing exams, fitting evaluations, and over-the-counter hearing aids with no copay and no coinsurance, providing up to $300 annually for OTC devices. Prescription hearing aids are partially covered with no copay and no coinsurance up to $1,500 per year, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Wellpoint Lung Care 2 (HMO-POS C-SNP), featuring eye exams with a copay of $0 to $35 and no coinsurance, including one routine exam per year with no copay. Eyewear is covered up to a $175 annual limit with no copay and no coinsurance, though upgrades are not covered.
Dental Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) offers partially covered dental services up to a $1,000 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive treatments. While Medicare-covered dental services require a $0 to $35 copay and no coinsurance, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers home infusion bundled services, which require prior authorization. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellpoint Lung Care 2 (HMO-POS C-SNP) with no copay and no coinsurance. This coverage ensures you can receive essential dialysis treatments with zero out-of-pocket costs.
Medical Equipment See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers medical equipment, with prior authorization required for services. Durable medical equipment and prosthetics are covered with no copay and 0% to 20% coinsurance, while diabetic supplies and therapeutic shoes or inserts are offered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) covers diagnostic tests and lab services with no copay or coinsurance, and outpatient X-rays for a $15 copay. Diagnostic radiological services require a copay between $0 and $150 with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by Wellpoint Lung Care 2 (HMO-POS C-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Wellpoint Lung Care 2 (HMO-POS C-SNP). None of the sub-services are covered, including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Wellpoint Lung Care 2 (HMO-POS C-SNP) with prior authorization, though additional days beyond the Medicare-covered limit are not covered. There is no copay and no coinsurance for days 1 through 20, followed by a daily copay of $218 and no coinsurance for days 21 through 100.
Other Services See details
Wellpoint Lung Care 2 (HMO-POS C-SNP) partially covers Other Services with no copay or coinsurance for over-the-counter (OTC) items, meal benefits, and Medicare Community Resource Support, while acupuncture and highly integrated dual-eligible SNP services are not covered. Covered benefits include a $42 quarterly OTC allowance and meal benefits for chronic conditions, which require prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved