Astiva Health C-SNP WOW (HMO C-SNP)
Astiva Health · HMO C-SNP · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $4.40
- Higher than most plans here
- Most you pay in a year for covered care in network
- $9,250
- Tied for highest here
- Drug deductible
- $615
- Medicare star rating
- 4 of 5
This is a special needs plan. Only some people can join: Chronic or Disabling Condition.
In plain English
Compared with the 25 other plans in San Diego County that the same person could join.
What stands out
- $0 for a 5-day hospital stay, tied for lowest here
- Dental, vision and hearing extras included
Watch out for
- $4.40 monthly premium, higher than most plans here
- Up to $9,250 a year for covered care, tied for highest here
- 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$52.80$52.80 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$52.80$52.80 in premiums + $0 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Not counted, because the plan charges a percentage: X-rays.
- A hard year$367.80$52.80 in premiums + $315 for careHigher than most plans 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: MRI, CT and other scans.
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 visit$0Referral neededPlan approval may be needed
- Urgent care$0
- Emergency room$115Not charged if you stay in the hospital within 48 hours
- Hospital stay$0 for days 1 to 60, then $419 a day for days 61 to 90Tied for lowest hereReferral neededPlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center20%Referral neededPlan approval may be needed
- Outpatient hospital care20%
- X-rays20%Referral neededPlan approval may be needed
- MRI, CT and other scans20%Referral neededPlan approval may be needed
- Ground ambulance$200Higher than most plans herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $218 a day for days 21 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 25 other plans in San Diego County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $15 |
| 3Preferred BrandAfter the deductible | $35 |
| 4Non-Preferred DrugAfter the deductible | $95 |
| 5Specialty TierAfter the deductible | 25% of the price |
| 6Select Care Drugs | $0 |
For a 1-month supply. The $615 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 2026, 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 $550 every three months. Plan pays up to $550 every three 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 IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included36 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 2026?”