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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 2026, 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 4 out of 5 stars in 2026.
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 $4.80. 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 $545.00 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 D-SNP) prescription drug plan features an annual drug deductible of $545. For generic medications, Tier 1 preferred generics have a 1-month copay starting at $18, while Tier 2 generics start at $19, with both tiers offering no copay for a 3-month supply through preferred mail order. Additionally, Tier 6 select care drugs are highly accessible, requiring no copay regardless of the pharmacy type or supply duration. Higher-tier medications require coinsurance rather than set copays, including a 20% coinsurance for Tier 3 preferred brands and a 32% coinsurance for Tier 4 non-preferred drugs. Specialty drugs in Tier 5 carry a 25% coinsurance for a 1-month supply at both preferred and standard pharmacies. Utilizing preferred pharmacies and preferred mail order services helps members secure the lowest out-of-pocket costs under this plan.
Additional Benefits
The Wellcare Dual Access (HMO D-SNP) plan offers comprehensive coverage where most outpatient, specialist, and diagnostic services require no copay and a 20% coinsurance. Inpatient hospital stays require a copayment of $2,180 for acute care and $2,080 for psychiatric care per stay, with no coinsurance. Emergency room visits have a $115 copay, while urgent care visits require a $40 copay, both of which feature no coinsurance. Many everyday healthcare benefits feature no copay and no coinsurance, including home health services, routine chiropractic and podiatry visits, and preventive dental care. The plan also covers routine vision and hearing services with no copay and a 20% coinsurance, alongside allowances of up to $300 for eyewear and $750 per ear for hearing aids with no copay or coinsurance. Additionally, members can access up to 24 free one-way transportation trips per year and select over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Dual Access (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a copayment of $2,180 and $2,080 per stay, respectively, both subject to prior authorization. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Wellcare Dual Access (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Dual Access (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. The plan also covers up to 24 one-way transportation trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Access (HMO D-SNP) covers emergency services with a $115 copay and urgent care with a $40 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 lifetime maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access (HMO D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and 20% coinsurance, while telehealth services require a $0 to $40 copay and 20% coinsurance. Chiropractic services are partially covered, offering up to 24 routine visits per year with no copay and no coinsurance, though other chiropractic services are not covered. Routine podiatry is also covered for up to 6 visits per year with no copay and no coinsurance.
Preventive Services See details
Wellcare Dual Access (HMO D-SNP) preventive services are partially covered, offering annual physical exams, fitness benefits, remote access, and alternative therapies with no copay and no coinsurance. Kidney disease education and screenings for glaucoma, diabetes, and post-welcome visit EKGs have no copay and a 20% coinsurance. Sub-services including 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, smoking cessation, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Wellcare Dual Access (HMO D-SNP) provides partially covered hearing services with no deductible, offering routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Dual Access (HMO D-SNP) offers partially covered vision services with no deductibles, though prior authorization is required. Routine eye exams (one per year) and contact lenses are covered with no copay and 20% coinsurance, while eyeglasses, lenses, frames, and upgrades have no copay and no coinsurance up to a $300 annual maximum; other eye exam services are not covered.
Dental Services See details
Wellcare Dual Access (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 20% coinsurance, and other preventive and comprehensive dental benefits with no copay and no coinsurance. While a $3,000 annual maximum applies to comprehensive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Dual Access (HMO D-SNP) with no copay and a 15% coinsurance.
Medical Equipment See details
Wellcare Dual Access (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, though prior authorization is required. This coverage applies to medicare-covered diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Wellcare Dual Access (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Access (HMO D-SNP) covers cardiac rehabilitation services with no copay, but in practice only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Dual Access (HMO D-SNP) with no coinsurance and no copay for days 1 to 20 and 71 to 100, though a $218 daily copay applies for days 21 to 70. Prior authorization is required, and while a 3-day prior hospital stay is not required, additional days beyond the standard 100 days are not covered.
Other Services See details
Other services under Wellcare Dual Access (HMO D-SNP) are partially covered, featuring over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered, and a referral is required to access the meal benefit.
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