A non-government entity
Wellpoint Lung Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Lung 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 Lung Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Wellpoint Lung 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 2025.
It's important to know that Wellpoint Lung 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 Lung 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 Lung 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 Lung 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:
Sign up for Wellpoint Lung Care (HMO-POS C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellpoint Lung Care (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $7.50 copay at preferred pharmacies, while standard mail order has no copay. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still have to pay for excluded drugs that are covered under any enhanced benefit.
Additional Benefits
The Wellpoint Lung Care (HMO-POS C-SNP) plan offers comprehensive coverage with a focus on outpatient and preventative services. Many services have no copay, including primary care, preventive services, and home health services. The plan also provides coverage for dental, vision, and hearing services, with varying copays and coinsurance amounts. The plan covers a range of inpatient and outpatient services, including emergency care, with copays ranging from $0 to $210 depending on the service. Inpatient hospital stays have a copay for the first three days, then no copay for the remainder of the stay. The plan also includes coverage for medical equipment, home infusion, and dialysis, with coinsurance applying to some services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For the first 3 days of an Inpatient Hospital stay, there is a $120 copay per day, and days 4-90 have no copay; additional days are unlimited and have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $50, observation services have a $50 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay between $20 and $20, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan, requiring prior authorization, with a $20 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan. Ground and Air Ambulance Services each have a $210 copay, while Transportation Services to a plan-approved health-related location have a $0 copay for up to 24 one-way trips per year, and 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 Lung Care (HMO-POS C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services have a $35 copay; all have no coinsurance.
Primary Care See details
The Wellpoint Lung Care (HMO-POS C-SNP) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, but routine care is not covered. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, and Opioid Treatment Program Services all have a $20 copay. Physician Specialist Services have a copay between $0 and $20, Podiatry Services have a copay between $0 and $20, and Other Health Care Professional services have a copay between $0 and $20. Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams with no copay, and additional services like personal emergency response systems and fitness benefits with no copay, while some services like health education are not covered. Other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits are covered with no copay.
Hearing Services See details
The Wellpoint Lung Care (HMO-POS C-SNP) plan covers hearing exams for a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but the specific copay information is not provided, and the plan does not cover inner ear, outer ear, or over the ear prescription hearing aids; OTC hearing aids are covered with no copay.
Vision Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers vision services, including eye exams with a copay of $0-$20, and eyewear. Eyewear has a 20% coinsurance for contact lenses, and no copay for eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum plan benefit of $275 per year; however, upgrades are not covered.
Dental Services See details
The Wellpoint Lung Care (HMO-POS C-SNP) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Other dental services, such as Medicare dental services, restorative services, and orthodontics, are covered with a $20 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment includes Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, both with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $70, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $70, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization and a doctor's referral.
Home Health Services See details
Home Health Services are covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan 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 covered, but 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. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $140. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a monthly maximum of $80, and Meal Benefit with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved