Astiva Health C-SNP WOW (HMO C-SNP)
Astiva Health · HMO C-SNP · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $9,250
- Drug deductible
- $500
- Medicare star rating
- No rating yet
This is a special needs plan. Only some people can join: Chronic or Disabling Condition.
In plain English
Compared with the 37 other plans in San Bernardino County that the same person could join.
What stands out
- No monthly premium
- Dental, vision and hearing extras included
Watch out for
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$0$0 in premiums + $0 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Not counted, because the plan charges a percentage: Specialist visit, X-rays, Urgent care.
- A hard year$0$0 in premiums + $0 for careTied for lowest here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Not counted, because the plan charges a percentage: Specialist visit, Ground ambulance, Emergency room, Hospital stay.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit20%Referral neededPlan approval may be needed
- Urgent care20%
- Emergency room20%
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$0Referral neededPlan approval may be needed
- Outpatient hospital care20%
- X-rays20%Referral neededPlan approval may be needed
- MRI, CT and other scans$0Referral neededPlan approval may be needed
- Ground ambulance20%Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $221 a day for days 21 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 37 other plans in San Bernardino County that the same person could join. Read the plan’s 2027 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $0 |
| 3Preferred BrandAfter the deductible | $20 |
| 4Non-Preferred DrugAfter the deductible | 42% of the price |
| 5Specialty TierAfter the deductible | 28% of the price |
| 6Select Care Drugs | $0 |
For a 1-month supply. The $500 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2027, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay $0.Cleanings and exams: plan pays up to $1,500 every six months. Plan pays up to $1,500 every six months for all dental.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $300 every two years.
- Hearing IncludedHearing test: $0. Hearing aids covered.Hearing aids: plan pays up to $750 a year per ear.
- Over-the-counter items IncludedUp to $265 a month for things like vitamins, pain relief and bandages.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included46 one-way rides to medical visits a year.
What changed from 2026
- Monthly premium2026$4.40 a month2027$0 a month
- Drug deductible2026$6152027$500
- Specialist visit2026$0202720%
- Urgent care2026$0202720%
- Emergency room2026$115202720%
- Outpatient surgery center202620%2027$0
- MRI, CT and other scans202620%2027$0
- Ground ambulance2026$200202720%
- Skilled nursing facility2026$0 for days 1 to 20, then $218 a day for days 21 to 1002027$0 for days 1 to 20, then $221 a day for days 21 to 100
- Dental2026Cleanings and exams: $0. Fillings, crowns and dentures: you pay $0. Cleanings and exams: plan pays up to $550 every three months. Plan pays up to $550 every three months for all dental2027Cleanings and exams: $0. Fillings, crowns and dentures: you pay $0. Cleanings and exams: plan pays up to $1,500 every six months. Plan pays up to $1,500 every six months for all dental
- Over-the-counter items2026Covered for things like vitamins, pain relief and bandages2027Up to $265 a month for things like vitamins, pain relief and bandages
- Rides to care202636 one-way rides to medical visits a year202746 one-way rides to medical visits a year
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Astiva Health C-SNP WOW (HMO C-SNP), plan number H1993-008, for 2027?”