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Wellpoint Chronic Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Chronic 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 Chronic Care (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Wellpoint Chronic 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 Texas. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellpoint Chronic 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 Chronic 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 Chronic 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 Chronic 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 $3400.00 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 Chronic Care (HMO-POS C-SNP) Medicare plan offers a $0 prescription drug deductible, allowing your coverage to start immediately. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs at preferred, standard, and standard mail-order pharmacies. Tier 2 generic drugs also feature no copay at preferred pharmacies and standard mail-order services, while standard pharmacies charge a copay starting at $5 for a one-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance across preferred, standard, and standard mail-order pharmacies. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The Wellpoint Chronic Care (HMO-POS C-SNP) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no coinsurance for most doctor visits and hospital services. Primary care doctor visits, telehealth services, and annual wellness exams require no copay, while specialist visits and physical therapy feature low copays ranging from $0 to $20. Inpatient hospital stays require a $225 daily copay for the first five days and no copay for additional days, with no coinsurance required. For extra wellness support, the plan includes essential dental, vision, and hearing benefits with no copays for routine care. Members can take advantage of a $2,500 annual dental limit, a $325 yearly eyewear allowance, and up to $3,000 annually for prescription hearing aids with no copay or coinsurance. Additionally, the plan offers a $45 monthly over-the-counter allowance and up to 12 one-way transportation trips to approved locations with no copay.
Inpatient Hospital See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $225 daily copay for days 1 through 5 and no copay for additional days. Prior authorization is required, and non-Medicare-covered stays as well as hospital upgrades are not covered.
Outpatient Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $200 copay, observation services with a $200 copay per stay, and outpatient substance abuse sessions with a $10 copay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers partial hospitalization services with a $10.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellpoint Chronic Care (HMO-POS C-SNP), with ground and air ambulance services requiring a $274.00 copay and no coinsurance. Transportation services are partially covered, offering no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Wellpoint Chronic Care (HMO-POS C-SNP) with a $150 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $35 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum limit with a $150 copay and no coinsurance.
Primary Care See details
Wellpoint Chronic Care (HMO-POS C-SNP) offers primary care physician visits and telehealth benefits with no copay and no coinsurance. Other covered services, such as specialist visits, physical and occupational therapy, and mental health services, feature copays ranging from $0 to $20 with no coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Preventive Services under the Wellpoint Chronic Care (HMO-POS C-SNP) plan are partially covered with no copays and no coinsurance for covered benefits like annual physicals, kidney disease education, fitness benefits, and remote access technologies. However, several additional supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, and nutritional or dietary benefits.
Hearing Services See details
Hearing services are covered by Wellpoint Chronic Care (HMO-POS C-SNP), featuring a $10 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered with no copay or coinsurance up to a $3,000 annual limit, excluding inner ear, outer ear, and over-the-ear types, while OTC hearing aids are covered with no copay or coinsurance up to a $300 annual limit.
Vision Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) provides partially covered vision services, featuring one annual routine eye exam with no copay or coinsurance, while other eye exams are not covered. Eyewear is covered up to a $325 yearly limit with no copay and no coinsurance for eyeglasses, lenses, and frames, though contact lenses carry a 20% coinsurance and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Wellpoint Chronic Care (HMO-POS C-SNP) with a $10 copay and no coinsurance for Medicare-covered care, and no copay or coinsurance for other covered preventive and comprehensive services up to a $2,500 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Wellpoint Chronic Care (HMO-POS C-SNP) with no copay and no coinsurance.
Medical Equipment See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are covered with no copay and no coinsurance, subject to manufacturer limitations. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellpoint Chronic Care (HMO-POS C-SNP) with prior authorization required. Diagnostic tests and procedures feature no coinsurance and a $0 to $100 copay, lab services have no copay, outpatient X-rays cost a $5 copay, diagnostic radiological services require a minimum $5 copay, and therapeutic radiological services have a minimum 20% coinsurance.
Home Health Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, though standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization is required, and while a 3-day prior inpatient hospital stay is not required, additional days beyond the standard 100-day limit are not covered.
Other Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) partially covers other services with no copay and no coinsurance, including a chronic illness meal benefit, Medicare Community Resource Support, and a $45 monthly over-the-counter allowance. Acupuncture is not covered under this plan.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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