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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 New Jersey. This plan received an overall rating of 3 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 $340.00 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 $13900.00 (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 $13900.00 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 features an annual drug deductible of $340. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care Drugs) at preferred, standard, or standard mail-order pharmacies. For Tier 2 (Generic) drugs, you pay no copay through standard mail order, while retail copays range from $2 to $7 for a one-month supply depending on whether you use a preferred or standard pharmacy. For higher-tier medications, the plan transitions from flat copays to coinsurance. You will pay a 25% coinsurance for both Tier 3 (Preferred Brand) and Tier 4 (Non-Preferred Drug) prescriptions across preferred, standard, and standard mail-order options. Tier 5 (Specialty Tier) drugs require a 29% coinsurance for a one-month supply, which applies at both preferred and standard pharmacies as well as standard mail order.
Additional Benefits
The Wellpoint Kidney Care (HMO-POS C-SNP) plan offers comprehensive coverage for essential medical needs, featuring no copay and no coinsurance for inpatient hospital stays, primary care visits, and home health services. Outpatient services, specialist visits, diagnostic tests, and dialysis services generally require no copay but are subject to a 20% coinsurance. Emergency care is available with a $115 copay, while urgently needed services require a $25 copay, both with no coinsurance. Additionally, the plan includes valuable supplemental benefits such as routine dental care and hearing aids with no copay and no coinsurance up to specified annual limits. Routine vision exams and contact lenses require no copay and a 20% coinsurance, while eyeglasses are covered with no copay and no coinsurance. Members also benefit from up to 24 one-way transportation trips per year and over-the-counter items, both provided with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellpoint Kidney Care (HMO-POS C-SNP), offering acute and psychiatric care with no copay and no coinsurance, though Medicare-defined cost-sharing and prior authorization are required. Additional days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers outpatient services with no copay, though a 20% coinsurance and prior authorization apply to outpatient hospital, observation, 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
Partial hospitalization is covered by Wellpoint Kidney Care (HMO-POS C-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required for 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 rides. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are 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 $25 copay and no coinsurance. Some worldwide emergency 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 and telehealth services with no copay and no coinsurance, while other services like specialist visits, mental health, and physical therapy feature no copay and a 20% coinsurance. Chiropractic services are not covered in practice, as routine care and other chiropractic sub-services are excluded.
Preventive Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) preventive services are partially covered, featuring no copays or coinsurance for annual physicals, kidney disease education, diabetes self-management training, and remote access technologies. Glaucoma screenings and digital rectal exams require a 20% coinsurance and no copay, while several supplemental benefits—including fitness programs, health education, in-home safety assessments, nutritional counseling, and therapeutic massage—are not covered.
Hearing Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers hearing services, offering routine exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit, excluding inner ear, outer ear, and over-the-ear types, while over-the-counter hearing aids are covered with no copay or coinsurance up to a $300 annual limit.
Vision Services See details
Vision Services are partially covered by Wellpoint Kidney Care (HMO-POS C-SNP), with other eye exam services and eyewear upgrades not covered. One routine eye exam is covered annually with no copay, a 20% coinsurance, and no deductible, while covered eyewear has a $125 annual limit and no deductible, offering contact lenses with no copay and a 20% coinsurance, and eyeglasses with no copay and no coinsurance.
Dental Services See details
Dental services are partially covered by Wellpoint Kidney Care (HMO-POS C-SNP), excluding maxillofacial prosthetics, implant services, and orthodontics, up to a $1,200 annual maximum. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance.
Home Infusion bundled Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers dialysis services with a 20% coinsurance and no copay.
Medical Equipment See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers durable medical equipment with no copay and coinsurance ranging from no coinsurance to 20%, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers diagnostic and radiological services, including lab tests, therapeutic radiology, and outpatient X-rays, with no copay. A 20% coinsurance and prior authorization are required for all of these covered services.
Home Health Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellpoint Kidney Care (HMO-POS C-SNP) covers some cardiac rehabilitation services with no copay, subject to prior authorization. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellpoint Kidney Care (HMO-POS C-SNP) offers partially covered Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows SNF admission without a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Wellpoint Kidney Care (HMO-POS C-SNP), as acupuncture is not covered. Covered options include over-the-counter (OTC) items, meal benefits, and Medicare Community Resource Support, all of which require no copay and no coinsurance.
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