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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 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 Select Counties in TX. 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:
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Drug Coverage
The Wellpoint Lung Care (HMO-POS C-SNP) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $7.50 copay at a preferred pharmacy and a $12.50 copay at a standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellpoint Lung Care (HMO-POS C-SNP) plan offers comprehensive coverage with a variety of benefits. The plan includes no copay for primary care visits, many preventive services, and no copay for many services like outpatient blood services, and home health services. This plan also offers additional benefits such as hearing, vision, and dental services, with varying copays and coinsurance. Emergency services, ambulance services, and transportation services are covered with copays, and the plan also covers services like diagnostic, radiology, and cardiac rehabilitation services with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which have a $225 copay for days 1-5, and no copay for days 6-90. Additional days for both services are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan, including outpatient hospital services with a copay between $0 and $200, and observation services with a $200 copay. Ambulatory Surgical Center (ASC) Services and outpatient blood services have no copay, while individual and group outpatient substance abuse sessions have a copay of $10.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan, but requires prior authorization. The plan has a $10 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $293 copay, and air ambulance services with 20% coinsurance. Transportation Services to plan-approved health-related locations are covered with no copay, for up to 26 one-way trips per year. 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. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $90 copay, while Urgently Needed Services have a $35 copay.
Primary Care See details
Wellpoint Lung Care (HMO-POS C-SNP) covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $10 copay, Physician Specialist Services with a $10 copay, Mental Health Specialty Services with a $10 copay, Podiatry Services with a $0-$10 copay, Other Health Care Professional services with a $0-$20 copay, Psychiatric Services with a $10 copay, Physical Therapy and Speech-Language Pathology Services with a $10 copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $10 copay. Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services require prior authorization.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services. Annual physical exams have no copay, while additional services, including Fitness Benefit and Remote Access Technologies, may have a copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $10 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a maximum benefit of $3,000 per year, and OTC hearing aids with no copay and a maximum benefit of $300 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Wellpoint Lung Care (HMO-POS C-SNP) plan covers vision services, including eye exams with a copay of $0-$10 and eyewear with a 20% coinsurance for contact lenses, and no copay for eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $300 per year. Upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic and preventative services with no copay. Other dental services, such as Medicare Dental Services, and Restorative Services, require a $10 copay. The plan has a maximum benefit of $2,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs. Other Medicare Part B drugs have a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Lung Care (HMO-POS C-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has a coinsurance between 0% and 20%, while durable medical equipment for use outside the home is not covered. Medicare-covered prosthetic devices and medical supplies have a 20% coinsurance with no copay, while diabetic supplies and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $5 and $300, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $5 copay.
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 by the Wellpoint Lung Care (HMO-POS C-SNP) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellpoint Lung Care (HMO-POS C-SNP) plan, with a prior authorization requirement. For days 1-20, there is no copay, and for days 21-100, the copay is $140. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits 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.
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