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Wellpoint Kidney Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Kidney Care (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 Kidney Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Wellpoint Kidney Care (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 Select Counties in Texas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellpoint Kidney Care (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 Kidney Care (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 Kidney Care (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 Kidney Care (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 a $100.00 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 combined Maximum Out-Of-Pocket cost of $12450.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $12450.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Kidney Care (HMO-POS C-SNP) plan has a $100 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, there is no copay at preferred and standard pharmacies, and also no copay at standard mail order pharmacies. For specialty tier drugs, there is also no copay at preferred and standard pharmacies, and also no copay at standard mail order pharmacies. For standard generic drugs, you pay 10% coinsurance at preferred pharmacies and standard mail order pharmacies, and 15% coinsurance at standard pharmacies.
Additional Benefits
The Wellpoint Kidney Care (HMO-POS C-SNP) plan offers a range of benefits with varying cost-sharing options. Many services have no copay, including primary care visits, hearing exams, and home health services. However, you may encounter coinsurance for services like outpatient services, vision, and dental care. The plan provides coverage for both inpatient and outpatient services, as well as emergency and hearing services. Additionally, it includes coverage for medical equipment, home infusion, and dialysis services. Keep in mind that some services, such as cardiac rehabilitation, are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare-covered stays, and upgrades for inpatient hospital acute and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered. You will pay the Medicare-defined cost share for tier 1, with coinsurance applying.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay, and outpatient substance abuse services have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Kidney Care (HMO-POS C-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to plan-approved health-related locations are covered with no copay, and up to 86 one-way trips per year using rideshare, bus/subway, van, or medical transport are covered. Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered, with a $90 copay and no coinsurance for emergency services. Urgently Needed Services are also covered, with a $20 copay and no coinsurance. However, Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Wellpoint Kidney Care (HMO-POS C-SNP) plan covers Primary Care Physician Services with no copay, Chiropractic Services with 20% coinsurance, Occupational Therapy Services with 20% coinsurance, Physician Specialist Services with no copay and 20% coinsurance, Mental Health Specialty Services with 20% coinsurance, Podiatry Services with 20% coinsurance and no copay, Other Health Care Professional services with 20% coinsurance and no copay, Psychiatric Services with 20% coinsurance, Physical Therapy and Speech-Language Pathology Services with 20% coinsurance, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services such as Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas. Glaucoma Screening has a 20% coinsurance, while Diabetes Self-Management Training has no copay, and Barium Enemas have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and routine hearing exams have a 20% coinsurance. Prescription hearing aids have no copay, with a maximum benefit of $2,000 every year, and OTC hearing aids have no copay, with a maximum benefit of $300 every 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
Vision services include eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance and a $300 combined maximum plan benefit. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have no copay.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and Other Dental Services with a $2,000 maximum benefit per year. 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 are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. 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 Kidney Care (HMO-POS C-SNP) plan. There is no copay, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay and 0-20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay, and 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. You may have to pay up to 20% coinsurance for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the Wellpoint Kidney Care (HMO-POS C-SNP) plan with no copay and no coinsurance, though 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 Kidney Care (HMO-POS C-SNP) plan. 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 under the Wellpoint Kidney Care (HMO-POS C-SNP) plan. Prior authorization is required, and the plan follows the Medicare-defined cost share for tier 1, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The "Wellpoint Kidney Care (HMO-POS C-SNP)" plan covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $75.00 per month. The plan also covers meal benefits with no copay, and other services including Medicare Community Resource Support with no copay. 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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