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Wellpoint I Carelon Kidney Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint I Carelon 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 I Carelon Kidney Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Wellpoint I Carelon 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 Pima County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellpoint I Carelon 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 I Carelon 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 I Carelon 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 I Carelon 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3000.00 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 I Carelon Kidney Care (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 example, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy, and 20% coinsurance for standard generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, 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.
Additional Benefits
The Wellpoint I Carelon Kidney Care (HMO-POS C-SNP) plan offers a range of benefits with varying costs. Many services have no copay, including primary care, preventive services, hearing exams, vision exams and eyewear, dental services, and home health services. You'll pay a copay for inpatient hospital stays, outpatient services, ambulance services, emergency services, partial hospitalization, and chiropractic services. Additional benefits include coverage for home infusion, dialysis, and medical equipment, as well as diagnostic and radiological services, and skilled nursing facility stays. The plan also offers over-the-counter items and a meal benefit with no copay. However, it's important to note that certain services like cardiac rehabilitation, private duty nursing, and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $125 for days 1-5 and no copay for days 6-90; additional days are unlimited with no copay. Non-Medicare-covered stays and upgrades are not covered.
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 services have a copay between $0 and $50, observation services have a $50 copay, ambulatory surgical center services have no copay, individual and group substance abuse sessions have a $30 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint I Carelon Kidney Care (HMO-POS C-SNP) plan, including both ground and air ambulance services with a $195 copay. Transportation Services to a plan-approved health-related location are covered with no copay, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint I Carelon Kidney Care (HMO-POS C-SNP) plan. Emergency Services have a $120 copay, Urgently Needed Services have no copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Chiropractic Services have a $20 copay, while Other Health Care Professional and Opioid Treatment Program Services have copays that vary. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services, including Medicare-covered zero-dollar services and annual physical exams, are covered with no copay. Additional preventive services, including Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Kidney Disease Education Services are covered with no copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. However, services like Health Education, In-Home Safety Assessment, Personal Emergency Response System, 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 Benefit, 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, 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, routine hearing exams, fitting/evaluation for hearing aids, and OTC hearing aids have no copay. Prescription hearing aids (inner ear, outer ear, and over the ear) are not covered, and the prescription hearing aids (all types) has no copay.
Vision Services See details
The Wellpoint I Carelon Kidney Care (HMO-POS C-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses also have no copay. Eyeglass frames and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are unlimited, while eyewear has a combined maximum amount of $225 per year. Upgrades are not covered.
Dental Services See details
Dental services, including oral exams, dental x-rays, and other diagnostic dental services, are covered with no copay. Additionally, other preventive dental services, such as prophylaxis (cleaning) and fluoride treatment, are covered with no copay, and there is a $500 annual maximum benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with no copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint I Carelon Kidney Care (HMO-POS C-SNP) plan. There is no copay or coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetic Devices with 0% to 20% coinsurance, and Medical Supplies with 0% to 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, and lab services, with no copay for diagnostic procedures/tests and lab services, and a copay of at most $150 for diagnostic radiological services. Therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Wellpoint I Carelon Kidney Care (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 not covered by the Wellpoint I Carelon Kidney Care (HMO-POS C-SNP) plan. Specifically, 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, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items with no copay, and 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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