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Wellcare Dual Access (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (HMO 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 D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Access (HMO D-SNP) is a HMO D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in TX. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Dual Access (HMO 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 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 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 D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. 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 D-SNP) plan has a deductible of $590. After you meet your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D is $18.30. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The Wellcare Dual Access (HMO D-SNP) plan offers a range of benefits, including inpatient hospital stays with a $1580 copay per admission, and outpatient services with 20% coinsurance. Emergency services have a $110 copay, and urgent care has a $45 copay. Primary care and specialist visits have a 20% coinsurance, while preventative services, hearing exams, and dental cleanings are covered with no copay. This plan provides additional coverage for vision, dental, and hearing services. It also includes coverage for home health services with no copay, medical equipment with 20% coinsurance, and diagnostic services with up to 20% coinsurance. Other perks include transportation services, acupuncture, and an OTC allowance, all with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a copay of $1580 per admission or stay for Medicare-covered stays. Additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include Outpatient Hospital Services with a 20% coinsurance and no copay, Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance, Outpatient Substance Abuse Services with a 20% coinsurance, and Outpatient Blood Services with a 20% coinsurance. The Outpatient Blood Services benefit includes an enhanced benefit where the three (3) pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Dual Access (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Access (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services have no copay. Transportation services to any health-related location are not covered. Transportation services to plan approved health-related locations are covered for up to 60 one-way trips every year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Dual Access (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay, and there is no coinsurance for any of these services. Worldwide Urgent Coverage also has a $110 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access (HMO D-SNP) plan covers primary care physician services with a 20% coinsurance, and chiropractic services with no copay. Occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered with a 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services which require prior authorization and have a copay. Other covered services include Personal Emergency Response System (PERS), Alternative Therapies, Therapeutic Massage, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams and EKG following Welcome Visit. The coinsurance for Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams and EKG following Welcome Visit is 20%.
Hearing Services See details
Hearing exams are covered, with routine hearing exams and fitting/evaluation for hearing aids covered with no copay and a coinsurance of at most 20%, and prescription hearing aids are covered with no copay. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance and a copay for some services. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other services like oral exams, dental x-rays, and cleanings with no copay. Orthodontic services are covered up to a maximum of $3,000 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Other Medicare Part B drugs and Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the Wellcare Dual Access (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Wellcare Dual Access (HMO D-SNP) plan. Durable Medical Equipment has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. For Prosthetic Devices, the coinsurance is 20%, and for Medical Supplies, the coinsurance is also 20% with no copay. Diabetic Supplies and Therapeutic Shoes/Inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and Lab Services have a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access (HMO 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 D-SNP) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access (HMO 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
Other Services include acupuncture with no copay and an annual limit of 24 treatments, over-the-counter (OTC) items with no copay, and a meal benefit with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and several other services are not covered.
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