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Wellpoint Chronic Care 2 (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Chronic 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 Chronic Care 2 (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Wellpoint Chronic 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 Chronic 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 Chronic 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 Chronic 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 Chronic 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 Chronic Care 2 (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy type. For preferred generic and specialty tier drugs, there is no copay. For standard generic drugs, you'll pay 15-20% coinsurance, and for preferred brand and non-preferred drugs, you'll pay 25-33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellpoint Chronic Care 2 (HMO-POS C-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, but outpatient services and many primary care services have no copay. The plan includes coverage for emergency services, hearing, vision, and dental, with specific copays or maximum benefits for each. Additional benefits include transportation services, home health services, and skilled nursing facility care with no copay for some services. There is coverage for medical equipment with coinsurance, as well as diagnostic and radiological services. The plan also offers over-the-counter items and a meal benefit, and offers no copay for dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $265 for days 1-6, and no copay for days 7-90. Additional days for both Inpatient Hospital-Acute and Psychiatric are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $175, observation services with a $175 copay, and outpatient substance abuse services with a $30 copay for both individual and group sessions. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $30 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Chronic Care 2 (HMO-POS C-SNP) plan. Ground and air ambulance services have a $195 copay, while transportation services to a plan-approved health-related location have no copay and covers 12 one-way trips per year via rideshare, bus/subway, van, and medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $90 copay, and Urgently Needed Services has a $15 copay. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, and Additional Telehealth Benefits have no copay. Chiropractic Services, Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services have a copay of $15.00. Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have variable copays. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include no copay for Medicare-covered services, annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additional preventive services, including fitness benefits and remote access technologies, have a copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, 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, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services 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 also have no copay. Prescription hearing aids have a $1,500 benefit per year, and OTC hearing aids have a $300 benefit per year with no copay.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a copay of $0-$35, while eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames have no copay, with a combined maximum benefit of $175 per year.
Dental Services See details
Dental Services are covered, with a $750 annual maximum. Medicare Dental Services have a copay between $0 and $35, and other services such as Oral Exams, Dental X-Rays, and more have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Chronic Care 2 (HMO-POS C-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% - 20% coinsurance, Prosthetics/Medical Supplies with 0% - 20% coinsurance, 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 are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $195, Therapeutic Radiological Services with a coinsurance of 20% or more, and Outpatient X-Ray Services with a $15 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellpoint Chronic 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. This benefit requires prior authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellpoint Chronic Care 2 (HMO-POS C-SNP) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Chronic Care 2 (HMO-POS C-SNP) plan. You will have no copay for days 1-20, and a $75 copay for days 21-100; there is no coinsurance.
Other Services See details
The Wellpoint Chronic Care 2 (HMO-POS C-SNP) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit coverage amount of $44.00 every three months. The plan also covers a Meal Benefit with no copay, but requires prior authorization. Acupuncture, 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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* 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.
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