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Wellcare Dual Access (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Access (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Access (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in Washington. The overall rating for this plan is not yet available for 2025.
It's important to know that Wellcare Dual Access (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Dual Access (HMO-POS D-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 Wellcare Dual Access (HMO-POS D-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 Wellcare Dual Access (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.20. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 Wellcare Dual Access (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you'll pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2,000. After that, you will enter the catastrophic coverage phase, and pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), also known as "Extra Help." If you qualify, you'll pay $19.20 per month for Part D.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers comprehensive coverage with a variety of benefits. The plan covers inpatient hospital stays with copays per admission, and outpatient services with a 20% coinsurance. Emergency, urgently needed, and worldwide emergency services have a copay, while primary care, specialist visits, and therapies have a 20% coinsurance. Preventive services, including an annual physical exam, are covered with no copay, and additional services such as hearing, vision, and dental services are also covered. The plan covers home health services and skilled nursing facilities. Additionally, the plan covers ambulance, transportation, and other services such as acupuncture and over-the-counter items.
Inpatient Hospital See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers inpatient hospital stays, including acute and psychiatric care. Inpatient Hospital-Acute has a copay of $1680 per admission or stay, while Inpatient Hospital Psychiatric has a copay of $1937 per admission or stay; additional days, non-Medicare covered stays, and upgrades for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services have a 20% coinsurance and no copay, while Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Dual Access (HMO-POS D-SNP) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and allow for 12 one-way trips per year using rideshare services, bus/subway, or medical transport.
Emergency Services See details
Emergency services, urgently needed services, and worldwide emergency coverage have a copay of $110, $45, and $110 respectively, with no coinsurance. Worldwide urgent coverage has a $110 copay and no coinsurance, while worldwide emergency transportation is not covered.
Primary Care See details
Primary Care Physician Services are covered with a 20% coinsurance. Chiropractic Services are covered with no copay. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a 20% coinsurance. Podiatry Services, Other Health Care Professional, and Additional Telehealth Benefits are covered, and Additional Telehealth Benefits have a $0-$45 copay and a 20% coinsurance.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional services such as Alternative Therapies, Fitness Benefit, Therapeutic Massage, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications with no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a maximum benefit of $1000 per year, and no copay for prescription hearing aids (all types).
Vision Services See details
Vision Services include eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance and a $200 combined maximum plan benefit. Routine eye exams have no copay and are limited to one per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers Medicare Dental Services with 20% coinsurance, while other dental services include oral exams, dental x-rays, and other diagnostic, preventive, restorative, and adjunctive general services with no copay, and Orthodontic Services with a $3,000 maximum benefit. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies have a coinsurance of 20%. Medical Supplies also have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests, lab services, and outpatient X-ray services. Diagnostic procedures/tests and radiological services have a coinsurance of at most 20%, while lab services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Wellcare Dual Access (HMO-POS D-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 not covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Specifically, 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 12 treatments per year. Over-the-counter items and meal benefits are also covered with no copay, although a doctor referral is required for meal benefits. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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