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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 TX. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2900.00 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 Kidney Care (HMO-POS C-SNP) plan has an enhanced alternative drug benefit with no deductible. In the initial coverage phase, you will pay a $5 copay for preferred generic drugs at a preferred pharmacy, and 20% coinsurance for standard generic drugs. For preferred brand drugs, you pay 25% coinsurance. For non-preferred drugs, you pay 33% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellpoint Kidney Care (HMO-POS C-SNP) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay of $125 for the first 5 days, with no copay for days 6-90. Outpatient services can have copays from $0 to $125, and emergency services have a $90 copay. The plan provides no copay for many services, including primary care, preventive services, and hearing aid fittings/evaluations. Dental services are covered with a $750 annual maximum and a $25 copay for Medicare dental services. The plan also offers coverage for home health services, dialysis services, and medical equipment with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For the first 5 days, there is a $125 copay, and days 6-90 have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay of $0 to $125, and observation services with a $125 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered with no copay, while outpatient substance abuse services have a $35 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Kidney Care (HMO-POS C-SNP) plan, with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Kidney Care (HMO-POS C-SNP) plan. Ground and air ambulance services have a $210 copay, while transportation services to a plan-approved health-related location have no copay. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Kidney Care (HMO-POS C-SNP) plan. Emergency Services have a $90 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Services have a $90 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, and Additional Telehealth Benefits have no copay, while Chiropractic Services have a $20 copay, and Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services have a $35 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, kidney disease education services, and other preventive services. Health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, 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, additional sessions of smoking cessation, enhanced disease management, telemonitoring services, and counseling services are not covered. Fitness benefits, personal emergency response systems, remote access technologies, home and bathroom safety devices and modifications, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a $3,000 maximum benefit per year, and OTC hearing aids are covered with no copay up to a $300 maximum benefit per year.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, and eyeglass lenses and frames. Eye exams have a copay of $0-$25, while eyewear has a 20% coinsurance and a copay for upgrades, and contact lenses, eyeglass lenses, and eyeglass frames have no copay.
Dental Services See details
The Wellpoint Kidney Care (HMO-POS C-SNP) plan covers dental services with a $750 annual maximum. Medicare Dental Services have a $25 copay, while 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 have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellpoint Kidney Care (HMO-POS C-SNP) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while 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 by 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) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with no copay, lab services with no copay, all radiological services, diagnostic radiological services with a copay up to $125, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with no copay. Prior authorization is required for all diagnostic and radiological 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. 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. 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 Wellpoint Kidney Care (HMO-POS C-SNP), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $140 per day. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Other 1, with no copay for either. Acupuncture, Meal Benefit, 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. Over-the-counter items have a maximum plan benefit coverage amount of $98.00 every three months.
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