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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 Harris County. 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 a $75.00 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 $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) prescription drug plan features a low annual deductible of $75. This plan offers excellent savings on generic medications, providing no copay for Tier 1 preferred generics and Tier 6 select care drugs. Additionally, Tier 2 generic drugs have no copay when filled at a preferred pharmacy or through standard mail order, though standard pharmacies charge a copay starting at $10. For brand-name and specialty drugs, costs are structured as a percentage of the drug cost. Tier 3 preferred brand drugs require a 20% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs carry a flat 30% coinsurance. Specialty medications in Tier 5 are covered with a 32% coinsurance for a one-month supply across all network pharmacies.
Additional Benefits
The Wellpoint Chronic Care (HMO-POS C-SNP) plan offers comprehensive medical coverage featuring low out-of-pocket costs and many services with no coinsurance. Members enjoy no copay for primary care visits, telehealth, home health care, and annual preventive services. For inpatient hospital stays, there is a $120 daily copay for the first three days and no copay for subsequent days, while emergency room visits require a $150 copay that is waived if admitted. Supplemental benefits include preventive and comprehensive dental care up to $2,500 annually and routine vision exams with no copay, plus a $300 annual eyewear allowance. Hearing care is also highly covered, providing no copay for routine exams and up to $3,000 annually for prescription hearing aids. Additionally, the plan provides practical extras like a $40 monthly over-the-counter allowance and up to 12 one-way trips per year for plan-approved transportation.
Inpatient Hospital See details
Wellpoint Chronic Care (HMO-POS C-SNP) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, featuring a $120 daily copay for days 1 to 3 and no copay for days 4 and beyond. Prior authorization is required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services carry a copay of $0 to $50, observation services have a $50 copay per stay, and outpatient substance abuse sessions require a $20 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellpoint Chronic Care (HMO-POS C-SNP) for a $20.00 copay with no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers ground and air ambulance services with a $210 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers emergency services 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 $35 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 lifetime maximum with a $150 copay and no coinsurance.
Primary Care See details
Wellpoint Chronic Care (HMO-POS C-SNP) offers primary care and telehealth services with no copay and no coinsurance, while specialist, therapy, and mental health services require a $0 to $20 copay and no coinsurance. For chiropractic benefits, some services are covered but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) offers preventive services with no copay and no coinsurance, covering annual physicals, kidney disease education, glaucoma screenings, and diabetes self-management. Additional preventive benefits are partially covered, providing fitness benefits, remote access, and personal emergency response systems with no copay, though services like health education, nutritional therapy, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Wellpoint Chronic Care (HMO-POS C-SNP), featuring a $20 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 up to $3,000 yearly with no copay or coinsurance, excluding inner ear, outer ear, and over the ear types, while OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Wellpoint Chronic Care (HMO-POS C-SNP), featuring one routine eye exam per year with no copay and no coinsurance, and a $300 annual allowance for eyewear. Eyeglasses and lenses are available with no copay and no coinsurance, while contact lenses require no copay and a 20% coinsurance; however, other eye exams and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Wellpoint Chronic Care (HMO-POS C-SNP) up to a $2,500 annual limit, featuring a $20 copay and no coinsurance for Medicare-covered dental services, and no copay and no coinsurance for other covered preventive and comprehensive dental benefits. Implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellpoint Chronic Care (HMO-POS C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while other covered Part B chemotherapy, radiation, and miscellaneous drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers medical equipment with no copays for all categories, though coinsurance rates apply for some items. Durable medical equipment has no copay and 0% to 20% coinsurance, prosthetics and medical supplies have no copay and 20% coinsurance, and diabetic equipment is available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers diagnostic and radiological services, requiring prior authorization and referrals. Diagnostic services feature no coinsurance, with no copay for lab services and a copay of $0 to $70 for other diagnostic tests. Radiological services require a $10 copay for outpatient X-rays, a minimum $10 copay for diagnostic radiology, and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Wellpoint Chronic Care (HMO-POS C-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Wellpoint Chronic Care (HMO-POS C-SNP) with no coinsurance and required prior authorization, although some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. For these services, copayments range from $20 to $25.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Wellpoint Chronic Care (HMO-POS C-SNP) 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 inpatient hospital stay is not required, and additional days beyond the Medicare-covered 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, which includes a $40 monthly over-the-counter allowance, chronic illness meal benefits, and Medicare Community Resource Support with a referral. Acupuncture is not covered under this benefit.
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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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