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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 2026, 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 2026.
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 $350.00 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) prescription drug plan features an annual drug deductible of $350. Under this plan, you will enjoy no copay for Tier 1 preferred generic and Tier 6 select care drugs at preferred, standard, and mail-order pharmacies. Tier 2 generic medications also feature no copay at preferred pharmacies, while standard pharmacies require a copay starting at $10 for a one-month supply. For higher-tier prescription drugs, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 10% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 30% coinsurance across all pharmacy options. Tier 5 specialty medications require a 29% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Wellpoint Kidney Care (HMO-POS C-SNP) plan offers robust medical coverage with many key services featuring no copay, though a standard 20% coinsurance applies to outpatient care, specialist visits, diagnostics, and dialysis. Beneficiaries can access primary care, telehealth, home health, and skilled nursing facility services with no copay and no coinsurance. Emergency care requires a $115 copay, while urgently needed care has a $40 copay. Additionally, the plan provides supplemental benefits with no copay or coinsurance, including up to $2,000 for dental care, a $325 annual eyewear allowance, and an $80 monthly allowance for over-the-counter items. Hearing aids are also covered with no copay or coinsurance, offering up to $300 annually for over-the-counter devices and up to $2,000 for prescription devices. Routine transportation services are also included, providing up to 26 one-way trips per year to plan-approved locations with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital and psychiatric care are covered by Wellpoint Kidney Care (HMO-POS C-SNP) with no copay, though prior authorization is required and Medicare-defined coinsurance and cost-sharing apply. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under Wellpoint Kidney Care (HMO-POS C-SNP) are covered with no copays, though a 20% coinsurance and prior authorization apply to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellpoint Kidney Care (HMO-POS C-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services. Transportation services are partially covered, offering up to 26 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers primary care physician services and telehealth visits with no copay and no coinsurance. Other primary care benefits, including specialist visits, mental health services, and physical therapy, require no copay and a 20% coinsurance, while chiropractic services are partially covered with routine and other chiropractic care excluded.
Preventive Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers preventive services, including an annual physical exam, kidney disease education, and select fitness and response systems with no copay and no coinsurance. Glaucoma screenings and digital rectal exams are covered with a 20% coinsurance, while additional preventive services are only partially covered, excluding sub-services such as health education, in-home safety assessments, medical nutrition therapy, and alternative therapies.
Hearing Services See details
Hearing services under Wellpoint Kidney Care (HMO-POS C-SNP) include fitting evaluations with no copay and annual routine exams with no copay and 20% coinsurance. The plan also covers OTC hearing aids up to $300 annually and prescription hearing aids up to $2,000 annually with no copay or coinsurance, though inner, outer, and over-the-ear prescription models are not covered and prior authorization is required.
Vision Services See details
Vision services are partially covered under the Wellpoint Kidney Care (HMO-POS C-SNP) plan, which features no deductibles and a $325 annual limit for eyewear. One routine eye exam per year and contact lenses are covered with no copay and a 20% coinsurance, while eyeglasses, lenses, and frames have no copay and no coinsurance; however, other eye exam services and upgrades are not covered.
Dental Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) dental services are partially covered, offering Medicare-covered dental with no copay and 20% coinsurance, and other preventive and comprehensive services with no copay and no coinsurance up to a $2,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and prior authorization is required for several comprehensive services.
Home Infusion bundled Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) partially covers Home Infusion bundled Services with no copay, as Part D home infusion drugs are not covered. Covered Medicare Part B insulin requires a $35 copay and no coinsurance, while Part B chemotherapy and other Part B drugs require no copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellpoint Kidney Care (HMO-POS C-SNP) plan with a 20% coinsurance and no copay.
Medical Equipment See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, including supplies and therapeutic shoes, is covered with no copay and no coinsurance, though manufacturer limits and prior authorization requirements may apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellpoint Kidney Care (HMO-POS C-SNP) with no copay and a 20% coinsurance, although prior authorization is required. This coverage applies to all diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers Cardiac Rehabilitation Services with no copay and 20% coinsurance, requiring prior authorization. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellpoint Kidney Care (HMO-POS C-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) offers partially covered other services with no copay and no coinsurance for meal benefits, Medicare Community Resource Support, and up to $80 monthly in over-the-counter items. Acupuncture is not covered under this plan.
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