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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 2026, 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 2026.
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 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 Lung Care (HMO-POS C-SNP) Medicare plan features an annual prescription drug deductible of $75. For Tier 1 preferred generics and Tier 6 select care drugs, members enjoy no copay for all supply lengths at preferred, standard, and standard mail-order pharmacies. Tier 2 generic medications also feature no copay at preferred pharmacies and through standard mail order, though standard retail pharmacies require a copay starting at $10 for a one-month supply. Higher-tier medications under this plan are subject to coinsurance. Tier 3 preferred brand drugs require a 20% coinsurance at preferred pharmacies and standard mail order, rising to 25% at standard retail pharmacies. Tier 4 non-preferred drugs carry a flat 30% coinsurance, while Tier 5 specialty drugs require a 32% coinsurance for a one-month supply.
Additional Benefits
The Wellpoint Lung Care (HMO-POS C-SNP) plan offers comprehensive medical coverage with low out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $120 daily copay for the first three days and no copay for subsequent days, while emergency room visits require a $150 copay which is waived if admitted. Specialist visits and outpatient services are also affordable, with copays ranging from no copay up to $50 and no coinsurance. Supplemental benefits further enhance this plan, providing dental care up to $2,500 annually and routine vision exams with no copay or coinsurance. Members also receive a $300 annual eyewear allowance, up to $3,000 for prescription hearing aids, and a $40 monthly over-the-counter allowance with no copays. Additionally, the plan covers up to 12 one-way trips per year to plan-approved locations with no copay and no coinsurance.
Inpatient Hospital See details
Wellpoint Lung Care (HMO-POS C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $120 daily copay for days 1 through 3 and no copay for days 4 and beyond. Prior authorization is required, and non-Medicare-covered stays and hospital upgrades are not covered.
Outpatient Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers outpatient services with no coinsurance, although prior authorization and referrals are required for most services. Members will pay a copay of $0 to $50 for outpatient hospital and observation services, $20 for outpatient substance abuse sessions, and no copay for ambulatory surgical center and blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellpoint Lung Care (HMO-POS C-SNP) with a $20.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Wellpoint Lung Care (HMO-POS C-SNP), as transportation to any health-related location is not covered. Ground and air ambulance services require a $210 copay and no coinsurance, while up to 12 one-way trips per year to plan-approved locations are available with no copay and no coinsurance.
Emergency Services See details
Wellpoint Lung 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 are covered with a $35 copay and no coinsurance, while worldwide emergency, urgent, and transportation services have a $150 copay and no coinsurance up to a $100,000 maximum plan limit.
Primary Care See details
Wellpoint Lung Care (HMO-POS C-SNP) covers primary care physician visits and telehealth services with no copay and no coinsurance. Other primary care benefits, including specialist visits, physical therapy, and mental health services, require a copay of up to $20 and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Wellpoint Lung Care (HMO-POS C-SNP) with no copay and no coinsurance for services like annual physical exams, kidney disease education, and select screenings. The benefit is partially covered, as sub-services such as health education, in-home safety assessments, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers hearing services, offering Medicare-covered exams for a $20 copay and no coinsurance, alongside routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered up to $3,000 annually with no copay and no coinsurance, though inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are also covered up to $300 annually with no copay and no coinsurance.
Vision Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers vision services, including one routine eye exam per year with no copay or coinsurance, and a $300 annual eyewear allowance with no copay for eyeglasses and a 20% coinsurance for contact lenses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Wellpoint Lung Care (HMO-POS C-SNP) up to a $2,500 yearly maximum, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $20 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance.
Home Infusion bundled Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers Home Infusion bundled Services with no copay, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Wellpoint Lung Care (HMO-POS C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Lung Care (HMO-POS C-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetic devices and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Lung Care (HMO-POS C-SNP) covers diagnostic and radiological services, requiring prior authorization and referrals for all care. Lab services and outpatient X-rays have no copay, diagnostic tests have a $0 to $70 copay with no coinsurance, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellpoint Lung Care (HMO-POS C-SNP) plan with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellpoint Lung Care (HMO-POS C-SNP) with no coinsurance and require prior authorization, though in practice only some services are covered as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellpoint Lung Care (HMO-POS C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, a $218 copay per day for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellpoint Lung Care (HMO-POS C-SNP) offers select additional services with no copay and no coinsurance, including a $40 monthly over-the-counter allowance, a chronic illness meal benefit, and Medicare Community Resource Support with a referral. However, acupuncture and dual-eligible highly integrated services are 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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