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Wellcare Dual Reserve (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (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 Reserve (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Reserve (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 Reserve (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 Reserve (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 Reserve (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 Reserve (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $6.20. 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 $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 $6500.00 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 Reserve (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, copays start at $18 at preferred pharmacies, with no copay for a three-month supply filled through preferred mail order. Tier 2 generic drugs cost $19 for a one-month supply at preferred pharmacies, though you can also secure a three-month supply with no copay via preferred mail order. Tier 3 preferred brand drugs and Tier 5 specialty drugs both require a 25% coinsurance, while Tier 4 non-preferred drugs carry a $100 copay for a one-month supply. Tier 6 select care drugs offer excellent savings with no copay for any supply length at preferred pharmacies, or a low $5 copay for a one-month supply at standard pharmacies.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers robust coverage with major cost savings, including no copays or coinsurance for primary care visits, annual physicals, routine vision and hearing exams, and preventive dental care. For specialized care, members can expect low copays ranging from $10 to $25 for specialist visits, alongside a $2,000 annual allowance for comprehensive dental services with no copay. This plan helps keep everyday healthcare affordable by eliminating deductibles for vision services and offering home health care with no copay. For more intensive medical needs, inpatient hospital stays require copays of $400 to $450 for the first five days with no coinsurance, while emergency room visits carry a $130 copay. Skilled nursing facility stays feature no copay for the first 20 days, and durable medical equipment is covered with a 20% coinsurance and no copay. Additionally, the plan provides valuable extras like routine transportation for up to 12 one-way trips per year and home infusion services with no copay.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $450 copay for days 1-5 of acute stays and a $400 copay for days 1-5 of psychiatric stays, followed by no copay for remaining covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $450, plus observation services with a $130 to $450 copay per stay. Ambulatory surgical center services require a $250 copay and outpatient substance abuse sessions have a $25 copay, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers partial hospitalization benefits with a $140.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers ground and air ambulance services with a $300 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers emergency services with a $130 copay and urgently needed services with a $35 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers primary care physician services with no copay and no coinsurance, and telehealth benefits with a $0 to $35 copay and no coinsurance. Specialist visits, mental health, and therapy services require no coinsurance and copays ranging from $10 to $25, while chiropractic benefits are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers preventive services with no copays and no coinsurance for annual physicals, fitness benefits, alternative therapies, and remote access technologies, though kidney disease education requires a 20% coinsurance with no copay. This plan partially covers additional preventive benefits, excluding services such as health education, weight management programs, personal emergency response systems, and nutritional counseling.
Hearing Services See details
Hearing services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no coinsurance, featuring a $10 copay for Medicare-covered exams and no copay for annual routine exams and hearing aid fittings. Prescription hearing aids are partially covered with no copay up to $500 per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no coinsurance and no deductible, as other eye exam services are not covered. Covered benefits include one routine eye exam per year and eyewear up to a $200 annual limit, both with no copay.
Dental Services See details
Dental services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), offering Medicare-covered dental with a $10 copay and no coinsurance, and most preventive and comprehensive services with no copay and no coinsurance up to a $2,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) 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 chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with 20% coinsurance and no copay for most items. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers diagnostic services with no coinsurance, featuring no copay for lab services and copays from $0 to $30 for diagnostic procedures. Radiological services require prior authorization and carry a $50 copay plus coinsurance for X-rays, a minimum 20% coinsurance plus copay for therapeutic radiology, and copays starting at $0 with no coinsurance for diagnostic radiology.
Home Health Services See details
Home health services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Wellcare Dual Reserve (HMO-POS D-SNP) with no coinsurance, but only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20 and days 51 through 100, a $218 daily copay for days 21 through 50, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay and no coinsurance, including acupuncture, over-the-counter items, and chronic illness meal benefits, while highly integrated SNP services are not covered. Prior authorization is required for acupuncture, which is limited to 12 treatments per year, and a referral is required for the meal benefit.
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