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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 TX. 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 $275.00 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 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) prescription drug plan features an annual drug deductible of $275. Enrollees benefit from no copay on Tier 1 (Preferred Generic) and Tier 6 (Select Care Drugs) prescriptions across preferred, standard, and standard mail-order pharmacies. Tier 2 (Generic) medications also feature no copay at preferred and standard mail-order locations, while standard retail pharmacies require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 (Preferred Brand) drugs require a 20% coinsurance at preferred and standard mail-order pharmacies, rising to 25% at standard pharmacies. Tier 4 (Non-Preferred Drug) coverage carries a flat 25% coinsurance, while Tier 5 (Specialty Tier) medications require a 29% coinsurance for a one-month supply across all pharmacy types.
Additional Benefits
The Wellpoint Kidney Care (HMO-POS C-SNP) plan offers comprehensive coverage with predictable costs, featuring no copays for primary care visits, telehealth, and preventive services. For hospital stays, members pay a $125 daily copay for the first five days of inpatient care, after which there is no copay. Outpatient services, emergency care, and ambulance rides are also covered with fixed copays and no coinsurance, including up to 120 one-way trips with no copay for plan-approved transportation. Essential specialty care like dialysis requires a 20% coinsurance with no copay, while routine dental, vision, and hearing services are covered with no copays for standard exams. The plan also provides valuable supplemental benefits, including up to a $3,000 annual hearing aid allowance and a $115 quarterly allowance for over-the-counter items with no copay. Durable medical equipment and diabetic supplies are also covered, often with no copay and low to no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellpoint Kidney Care (HMO-POS C-SNP) with no coinsurance and a copay of $125 per day for days 1 through 5, followed by no copay for days 6 and beyond. Prior authorization is required, and upgrades as well as 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 coinsurance across all services, including no copay for ambulatory surgical center visits and outpatient blood services. Medicare-covered outpatient hospital services require a copay of $0 to $125, observation services require a $125 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers ground and air ambulance services with a $260 copay and no coinsurance. Transportation services are partially covered, offering up to 120 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Wellpoint Kidney Care (HMO-POS C-SNP) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits under Wellpoint Kidney Care (HMO-POS C-SNP) are covered with no coinsurance, featuring no copay for primary care physician visits and telehealth services. Other covered services like specialist visits, physical therapy, and mental health care require copays ranging from $0 to $35 with no coinsurance, though chiropractic care is only partially covered because routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellpoint Kidney Care (HMO-POS C-SNP) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and screenings. While some supplemental benefits like fitness and home safety modifications are included, other services such as health education, weight management, nutritional benefits, and in-home support are not covered.
Hearing Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers hearing services, including Medicare-covered exams for a $25 copay and no coinsurance, and routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually, excluding inner ear, outer ear, and over the ear types. OTC hearing aids are also covered up to $300 annually with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Wellpoint Kidney Care (HMO-POS C-SNP), featuring routine eye exams with no copay and no coinsurance, while other eye exam services are not covered. Covered eyewear has no copay, no deductibles, and a 20% coinsurance for contact lenses up to a $300 annual limit, though upgrades are not covered.
Dental Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) offers partially covered dental services, with Medicare-covered dental requiring a $25 copay and no coinsurance, and other covered preventive and comprehensive services having no copay and no coinsurance up to a $750 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellpoint Kidney Care (HMO-POS C-SNP) with a 20% coinsurance and no copay.
Medical Equipment See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers medical equipment with no copays, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. Diabetic supplies and therapeutic shoes are covered with no copays and no coinsurance, though manufacturer limits apply and prior authorization is required for certain items.
Diagnostic and Radiological Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic procedures, lab services, and diagnostic radiological services feature no copay and no coinsurance, whereas outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services require a minimum 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered by Wellpoint Kidney Care (HMO-POS C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Wellpoint Kidney Care (HMO-POS C-SNP) with no coinsurance and require prior authorization, though only some services are covered in practice. Standard cardiac, intensive cardiac, and SET for PAD rehabilitation services are not covered and require a $25 copay, while pulmonary rehabilitation is not covered and requires a $20 copay.
Skilled Nursing Facility (SNF) See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Wellpoint Kidney Care (HMO-POS C-SNP) with no copay and no coinsurance for a chronic illness meal benefit, Medicare Community Resource Support, and up to $115 every three months for over-the-counter items, though acupuncture is not covered.
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