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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 2026, 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 2026.
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 $7.60. 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 $615.00 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 $9250.00 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 features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, copayments start as low as $18 and $19 respectively for a one-month supply at preferred pharmacies, and there is no copay for a three-month supply filled through preferred mail order. Additionally, Tier 6 select care drugs offer no copay when filled at preferred pharmacies or through preferred mail order. For higher-tier medications, the plan utilizes a mix of copays and coinsurance. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a $100 copayment for a one-month supply. Standard pharmacies and standard mail order options are also available, though they typically carry slightly higher out-of-pocket costs than preferred network options.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers comprehensive medical coverage, featuring no copays and a 20% coinsurance for outpatient, specialist, and diagnostic services. Inpatient hospital stays require no coinsurance but carry flat copays, specifically $2,230 per acute stay and $2,080 per psychiatric stay. Emergency care is accessible with a $115 copay, while urgent care visits require a $40 copay, both of which feature no coinsurance. This plan also includes valuable supplemental benefits, such as dental, vision, and hearing services, which generally feature no copays and 20% or no coinsurance, including up to $1,000 per ear annually for prescription hearing aids. Additionally, members can access routine chiropractic care, home health services, and up to 12 one-way transportation trips per year with no copay and no coinsurance. Many of these specialized services, including durable medical equipment and home health, require prior authorization to ensure coverage.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Dual Access (HMO-POS D-SNP) and require prior authorization, featuring no coinsurance for covered stays. Acute hospital stays incur a $2,230 copay per stay and psychiatric stays incur a $2,080 copay per stay, though additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Wellcare Dual Access (HMO-POS D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Dual Access (HMO-POS D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations via rideshare, transit, or medical transport with no copay or coinsurance. Prior authorization is required for both ambulance and transportation services.
Emergency Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, both of which are waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access (HMO-POS D-SNP) covers primary care, specialist, and mental health services with no copay and 20% coinsurance, while podiatry is covered with no copay and no coinsurance. Chiropractic services are partially covered, offering routine care with no copay and no coinsurance for up to 12 visits annually, though other chiropractic services are not covered. Telehealth options are also available with a copay of $0 to $40 and 20% coinsurance.
Preventive Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers preventive services, including annual physical exams, fitness benefits, and alternative therapies with no copay and no coinsurance. Kidney disease education and other screenings are covered with no copay and a 20% coinsurance, though additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no deductible, offering annual routine exams for a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,000 per ear yearly with no copay or coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), excluding other eye exam services, and require prior authorization. Routine eye exams are covered once yearly with no copay and 20% coinsurance, while eyewear is covered up to a $200 annual limit with no deductible, offering contact lenses with no copay and 20% coinsurance, and eyeglasses, frames, and upgrades with no copay and no coinsurance.
Dental Services See details
Dental services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), featuring no copay and 20% coinsurance for Medicare-covered dental services, and no copay or coinsurance for most preventive and comprehensive services. Covered options include exams, cleanings, and restorative care, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Part B chemotherapy and other drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access (HMO-POS D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. This coverage includes outpatient diagnostic procedures, lab services, therapeutic radiological services, and X-rays.
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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan with no copay, but only some services are covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, without requiring a prior 3-day hospital stay. There is no copay for days 1 to 20 and days 71 to 100, a $218 daily copay for days 21 to 70, and additional days beyond the standard 100 days are not covered.
Other Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers other services with no copay and no coinsurance, including up to 12 acupuncture treatments per year, over-the-counter (OTC) items via reimbursement, and chronic illness meal benefits. Prior authorization is required for acupuncture, and a referral is required for the meal benefit.
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