2027 Medicare Advantage plan

Wellpoint Lung Care Select (HMO-POS C-SNP): 2027 benefits and costs

Wellpoint HMO-POS C-SNP Special Needs Plan

CMS plan ID: H8849-005-0 · Plan year: 2027

Wellpoint Lung Care Select (HMO-POS C-SNP) is a 2027 Medicare Advantage plan offered by Wellpoint. It is listed in Texas.

2027 plan costs at a glance

Monthly plan premium$0.00
Drug deductible$95.00
In-network medical out-of-pocket maximum$3,900.00
Organization
Wellpoint
Plan organization
WELLPOINT INSURANCE COMPANY
Parent company
Elevance Health, Inc.
Plan type
HMO-POS C-SNP
Part C premium
$0.00
Part D premium
$0.00
Prescription drug coverage
Yes
Special Needs Plan type
Chronic or Disabling Condition
2027 CMS Star Rating
Standard monthly Medicare Part B premium
$209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible
None
Combined in/out-of-network medical deductible
None
Out-of-network medical deductible
None
In-network medical maximum
$3,900.00
Combined in/out-of-network medical maximum
Not applicable
Out-of-network medical maximum
Not applicable

Who can join this Special Needs Plan?

This plan is for people with qualifying chronic or disabling conditions. The plan must confirm that your condition meets its eligibility rules.

Plan eligibility type
Chronic or Disabling Condition
Qualifying conditions
Chronic lung disorders

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
ServiceIn-networkWhat to know
Primary care doctor

$0.00 copay

Service-specific deductible
No
Specialist visit

$0.00 to $20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Telehealth

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Emergency care

$150.00 copay

Urgent care

$35.00 copay

Home health

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Dialysis

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Medicare-covered chiropractic

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Medicare-covered foot care

$0.00 to $20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Other health professionals

$0.00 to $20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–5: $95.00 copay per day

Days 6–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–5: $95.00 copay per day

Days 6–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $0.00 copay per day

Days 21–100: $221.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkWhat to know
Outpatient hospital care

$0.00 to $95.00 copay

Service-specific deductible
No
Hospital observation services

$95.00 copay

Service-specific deductible
No
Ambulatory surgical center

$0.00 to $65.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Outpatient blood

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

$0.00 to $70.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Laboratory services

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Diagnostic radiology (CT, MRI)

$0.00 to $70.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Therapeutic radiology

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
X-rays

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkWhat to know
Partial hospitalization

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Intensive outpatient program

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Substance use treatment, individual sessions

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Substance use treatment, group sessions

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Opioid treatment program

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Mental health, individual sessions

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Mental health, group sessions

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Psychiatry, individual sessions

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Psychiatry, group sessions

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Physical and speech therapy

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Cardiac rehabilitation

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Intensive cardiac rehabilitation

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Pulmonary rehabilitation

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Supervised exercise for peripheral artery disease

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

$225.00 copay

Service-specific deductible
No
Approval required
Yes
Air ambulance

$225.00 copay

Service-specific deductible
No
Approval required
Yes
Durable medical equipment

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Medical supplies

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic supplies

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Diabetic shoes and inserts

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Diabetic monitors

$0.00 copay; 20% coinsurance

Service-specific deductible
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkPoint-of-serviceWhat to know
Medicare-covered dental

$20.00 copay

Not summarized. Check coverage with the plan.

Oral examsAdditional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Dental X-raysAdditional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Other diagnostic dentalAdditional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Dental cleaningAdditional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
FluorideAdditional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Other preventive dentalAdditional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Restorative dental careAdditional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Root canal treatment (endodontics)Additional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Gum treatment (periodontics)Additional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Removable dentures (prosthodontics)Additional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Fixed dental restorations (prosthodontics)Additional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Oral surgeryAdditional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year
Other dental servicesAdditional plan benefit

$0.00 copay

20% to 50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$1,000.00
How often this limit applies
Every year

Vision benefits

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

$0.00 to $20.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Routine eye examsAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Medicare-covered eyewear

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Contact lensesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglasses, lenses and framesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglass lensesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglass framesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Routine hearing examsAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
Yes
Hearing aid fitting and evaluationAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
Yes
Prescription hearing aids (all types)Additional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Over-the-counter hearing aidsAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkWhat to know
Over-the-counter health itemsAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Limited-duration mealsAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Annual physical examAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Allowances and optional benefits

Combined OTC + Other Supplemental

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance
Over-the-counter health items; Additional Benefits for SSBCI
Service categories that apply to the combined supplemental benefits group for Special Supplemental Benefits for Chronically Ill (SSBCI) package(s)
Food and produce (SSBCI: Non-Health Related Benefits)
How benefits are provided
Catalogue Purchase; Claims Processing; Debit Card; Reimbursement
Advance choice of benefits required
No
Shared benefit limit
$40.00
How often this limit applies
Every one month
Are the benefits combined such that a single benefit maximum available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?
Yes
Shared limit on visits or trips
No

Benefits for qualifying members

Non-Health Related Benefits

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Overweight, obesity, and metabolic syndrome; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Immunodeficiency and Immunosuppressive disorders; Conditions associated with cognitive impairment; Conditions with functional challenges; Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell; Conditions that require continued therapy services in order for individuals to maintain or retain functioning; Other 1; Other 2; Other 3; Other 4
Qualifying conditions
Chronic Hypertension
Qualifying conditions
Osteoporosis
Qualifying conditions
Chronic back pain
Qualifying conditions
Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%
Included services
Food and produce
Applies to out-of-network or point-of-service care
No
Some package benefits are exempt from the deductible
No

Optional packages that cost extra

Enhanced Dental and Vision Package $39.00 extra per month

Enhanced Dental and Vision Package

The limits below apply only to this optional package.

Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?
No
Deductible applies
No
Included services
Oral Exams; Dental X-Rays; Dental cleaning; Fluoride Treatment; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Oral and Maxillofacial Surgery; Adjunctive General Services; Contact Lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; POS: POS option

Preventive Dental Package $12.00 extra per month

Preventive Dental Package

The limits below apply only to this optional package.

Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?
No
Deductible applies
No
Included services
Oral Exams; Dental X-Rays; Dental cleaning; Fluoride Treatment; POS: POS option

Dental and Vision Package $26.00 extra per month

Dental and Vision Package

The limits below apply only to this optional package.

Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?
No
Deductible applies
No
Included services
Oral Exams; Dental X-Rays; Dental cleaning; Fluoride Treatment; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Oral and Maxillofacial Surgery; Adjunctive General Services; Contact Lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; POS: POS option

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2; Tier 6 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier30 days60 days90 days
Tier 1Preferred Generic

$0.00

$0.00

Not listed
Tier 2Generic

$0.00

$0.00

$0.00

Tier 3Preferred Brand

20%

20%

20%

Tier 4Non-Preferred Drug

30%

30%

30%

Tier 5Specialty Tier

32%

Not listedNot listed
Tier 6Select Care Drugs

$0.00

$0.00

Not listed
Preferred retail: initial-coverage cost per prescription fill (continued: 100 days)
Drug tier100 days
Tier 1Preferred Generic

$0.00

Tier 6Select Care Drugs

$0.00

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier30 days60 days90 days
Tier 1Preferred Generic

$0.00

$0.00

Not listed
Tier 2Generic

$10.00

$20.00

$30.00

Tier 3Preferred Brand

25%

25%

25%

Tier 4Non-Preferred Drug

30%

30%

30%

Tier 5Specialty Tier

32%

Not listedNot listed
Tier 6Select Care Drugs

$0.00

$0.00

Not listed
Standard retail: initial-coverage cost per prescription fill (continued: 100 days)
Drug tier100 days
Tier 1Preferred Generic

$0.00

Tier 6Select Care Drugs

$0.00

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier30 days60 days90 days
Tier 1Preferred Generic

$0.00

$0.00

Not listed
Tier 2Generic

$0.00

$0.00

$0.00

Tier 3Preferred Brand

20%

20%

20%

Tier 4Non-Preferred Drug

30%

30%

30%

Tier 5Specialty Tier

32%

Not listedNot listed
Tier 6Select Care Drugs

$0.00

$0.00

Not listed
Standard mail order: initial-coverage cost per prescription fill (continued: 100 days)
Drug tier100 days
Tier 1Preferred Generic

$0.00

Tier 6Select Care Drugs

$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier34 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$10.00

Tier 3Preferred Brand

25%

Tier 4Non-Preferred Drug

30%

Tier 5Specialty Tier

32%

Tier 6Select Care Drugs

$0.00

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier30 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$10.00

Tier 3Preferred Brand

25%

Tier 4Non-Preferred Drug

30%

Tier 5Specialty Tier

32%

Tier 6Select Care Drugs

$0.00

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 2: Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 3: Preferred Brand

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 4: Non-Preferred Drug

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 5: Specialty Tier

Drugs included in this tier
Part D Drugs Only

Tier 6: Select Care Drugs

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
Yes
Initial-coverage prices also apply to drugs exempt from the deductible
Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

Texas