Wellpoint Kidney Care (HMO-POS C-SNP) Medicare Special Need Plan H2593-043 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $2900.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $275.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 471 beneficiaries
Introduction
Wellpoint Kidney Care is a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by Wellpoint. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $0.00 monthly premium, $0.00 medical deductible, and $2900.00 in-network maximum out-of-pocket. CMS Plan ID H2593-043 identifies this plan. The 2027 Part D prescription drug deductible is $275.00.
CMS reports 471 beneficiaries enrolled across all service areas. You must live in the plan's service area to enroll: See List.
Eligibility
Wellpoint Kidney Care is a Medicare C-SNP plan for individuals with specific chronic conditions.
- Special Needs Plan Type
- Chronic Condition Special Needs Plan (C-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan is for individuals with chronic kidney disease.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Plan Benefits
Wellpoint Kidney Care has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H2593-043.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay |
| Specialist | In-network: $0-$25 copay | In-network: $0-$25 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$125 copay | In-network: $0-$125 copay |
| Lab services | In-network: $0 copay | In-network: $0 copay |
| Outpatient x-rays | In-network: $0 copay | In-network: $0 copay |
| Diagnostic tests and procedures | In-network: $0 copay | In-network: $0 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $150 copay | $150 copay |
| Worldwide emergency care | Coming soon | $150 copay |
| Urgent care | $40 copay | $40 copay |
| Inpatient hospital care | In-network: Tier 1 $125 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
In-network: Tier 1 $125 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 |
| Ground ambulance | In-network: $260 copay | In-network: $260 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $25 copay | In-network: $35 copay |
| Outpatient group therapy | In-network: $25 copay | In-network: $35 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $125 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
In-network: Tier 1 $125 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $35 copay | In-network: $35 copay |
| Occupational therapy | In-network: $35 copay | In-network: $35 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay |
| Durable medical equipment | In-network: 20% coinsurance | In-network: 0%-20% coinsurance |
| Prosthetics | In-network: 20% coinsurance | In-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 20%-50% coinsurance |
In-network: $0 copay Out-of-network: 20%-50% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 20%-50% coinsurance |
In-network: $0 copay Out-of-network: 20%-50% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 20%-50% coinsurance |
In-network: $0 copay Out-of-network: 20%-50% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: 20%-50% coinsurance |
In-network: $0 copay Out-of-network: 20%-50% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: 20%-50% coinsurance |
In-network: $0 copay Out-of-network: 20%-50% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: 20%-50% coinsurance |
In-network: $0 copay Out-of-network: 20%-50% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: 20%-50% coinsurance |
In-network: $0 copay Out-of-network: 20%-50% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay | In-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay | In-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay |
| Prescription hearing aids | In-network: $0 copay You can choose for this plan to cover either your prescription or over-the-counter hearing aids each year, but not both. |
In-network: $0 copay |
| OTC hearing aids | In-network: $0 copay You can choose for this plan to cover either your prescription or over-the-counter hearing aids each year, but not both. |
In-network: $0 copay |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | In-network: $0 copay |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | In-network: $0 copay | In-network: $0 copay |
Certain preventive services are covered 100% by Wellpoint Kidney Care as a Part B benefit.
Prescription Drug Coverage
Wellpoint Kidney Care includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($27.50) |
| Supplemental Part D Premium: | $27.50 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $6.27 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $275.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Wellpoint starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Wellpoint Kidney Care may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
| Generic | $0.00 copay | $0.00 copay |
| Preferred Brand | 20% coinsurance | 20% coinsurance |
| Non-Preferred Drug | 29% coinsurance | 25% coinsurance |
| Specialty Tier | 30% coinsurance | 29% coinsurance |
| Select Care Drugs | Not available | $0.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H2593)
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Wellpoint
- Website
- Wellpoint Plan Page
- Providers
- Wellpoint Providers Page
- Formulary
- Wellpoint Formulary Page
- Pharmacy
- Wellpoint Pharmacy Page
- New Member Health Plan Help
- (833)668-0934
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)668-0944
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Wellpoint Kidney Care (H2593-043-0) is available in the following locations (click to open):
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Wellpoint (official source) | http://shop.amerigroup.com/medicare | October 4, 2026 |
| CMS.gov | Chronic Condition Special Needs Plans (C-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| Medicare.gov | Joining a plan | April 28, 2026 |
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