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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 New Jersey. 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 $160.00 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 $160 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $2 copay at preferred pharmacies, $7 at standard pharmacies, and no copay with standard mail order. For specialty tier drugs, there is no copay.
Additional Benefits
The Wellpoint Kidney Care (HMO-POS C-SNP) plan offers a range of benefits with varying cost-sharing. You'll find no copays for primary care visits, preventive services, home health services, and many dental and vision services. This plan also covers hearing services, including hearing exams and hearing aids, and offers coverage for eyewear. The plan includes coverage for outpatient services, ambulance, emergency services, and transportation to health-related locations, with some services requiring coinsurance. In addition, the plan covers home infusion bundled services, dialysis services, medical equipment, and diagnostic and radiological services. This plan also has coverage for OTC items and nicotine replacement therapy.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but additional days for inpatient hospital-acute, non-Medicare-covered stays for inpatient hospital-acute, upgrades for inpatient hospital-acute, additional days for inpatient hospital-psychiatric, and non-Medicare-covered stays for inpatient hospital-psychiatric are not covered. You will pay the Medicare-defined cost share for tier 1, and prior authorization is required.
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 and Observation Services have a 20% coinsurance, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Kidney Care (HMO-POS C-SNP) plan, requiring prior authorization, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellpoint Kidney Care (HMO-POS C-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay and are limited to 80 one-way trips per year. Transportation services to any 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 copay of $110, while Urgently Needed Services have a copay of $25; both have no coinsurance. However, Worldwide Emergency Services and its sub-services 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 personal emergency response systems and remote access technologies with no copay. Other preventive services include glaucoma screening, barium enemas, digital rectal exams, and EKG following Welcome Visit. Some services, such as health education, are not covered.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and a 20% coinsurance, while fitting/evaluation for hearing aids have no copay and no coinsurance. Prescription hearing aids have a maximum benefit of $2,000 per year, with no copay, while OTC hearing aids have no copay and a maximum benefit of $300 per year.
Vision Services See details
Vision Services include eye exams with 20% coinsurance and routine eye exams with no copay, as well as eyewear with 20% coinsurance, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. The plan offers a combined maximum of $500 per year for eyewear.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services, and other dental services are covered up to a maximum of $750 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics all have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under 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 coverage for Durable Medical Equipment (DME), with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies, with a 20% coinsurance, but DME for use outside the home is not covered. Diabetic Equipment is also covered, and includes no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
The Wellpoint Kidney Care (HMO-POS C-SNP) plan covers diagnostic and radiological services. There is no copay for diagnostic or outpatient radiological services, but you may have to pay up to 20% coinsurance for diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered 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. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
The Wellpoint Kidney Care (HMO-POS C-SNP) plan covers over-the-counter items with no copay, a maximum benefit coverage amount of $150 every three months, and offers nicotine replacement therapy and Naloxone coverage. Other services like acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others are not covered.
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