A non-government entity
Wellcare Dual Reserve (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (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 Reserve (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Reserve (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 Reserve (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 Reserve (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 Reserve (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 Reserve (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 $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 $3450.00 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:
Sign up for Wellcare Dual Reserve (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Dual Reserve (HMO D-SNP) plan features an annual drug deductible of $615, though Select Care Drugs under Tier 6 are available with no copay across all pharmacies and mail-order options. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply at preferred pharmacies, with the added benefit of no copay for three-month supplies ordered through preferred mail delivery. Brand-name and specialty medications under Tier 3 and Tier 5 require a 25% coinsurance across both preferred and standard pharmacies. Non-preferred drugs under Tier 4 are subject to a $100 copay for a one-month supply at both preferred and standard retail pharmacies.
Additional Benefits
The Wellcare Dual Reserve (HMO D-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, home health services, and routine preventive care. For specialized care, members pay a $25 copay for specialist visits and routine hearing exams, while emergency room visits carry a $150 copay that is waived if admitted. Inpatient hospital stays feature no coinsurance, requiring a $200 daily copay for the first five days and no copay for days six through ninety. This plan also provides robust supplemental benefits, including no copay for preventive dental services up to a $3,000 annual limit and no copay for routine annual eye exams. Additionally, members can access up to 36 one-way transportation trips to plan-approved locations with no copay and receive prescription hearing aids up to $750 per ear annually with no copay. Over-the-counter items and chronic illness meals are also covered with no copay, making everyday health management highly affordable.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO D-SNP) offers partially covered inpatient hospital services with no coinsurance and a $200 daily copay for days 1 through 5, followed by no copay for days 6 through 90, though prior authorization is required. Additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Dual Reserve (HMO D-SNP) covers outpatient services with no coinsurance, featuring copays of $0 to $250 for outpatient hospital services, $150 to $250 per stay for observation services, and $150 for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellcare Dual Reserve (HMO D-SNP) with a $175.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Dual Reserve (HMO D-SNP) covers ground and air ambulance services with a $250 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Reserve (HMO D-SNP) covers emergency services with a $150 copay and no coinsurance, and urgent care with a $25 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to $50,000 with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and therapy services require a $25 copay and no coinsurance. Telehealth services have a copay of $0 to $25 and no coinsurance, but podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Wellcare Dual Reserve (HMO D-SNP) with no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes training, and select supplemental benefits, while kidney disease education has no copay but a 20% coinsurance. Additional preventive services are partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Wellcare Dual Reserve (HMO D-SNP), offering Medicare-covered exams for a $25 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Dual Reserve (HMO D-SNP) partially covers vision services with no coinsurance and no deductibles, though other eye exam services are not covered. Eye exams carry a copay of $0 to $25 (with no copay for one annual routine exam), and eyewear is covered with no copay up to a $200 yearly limit.
Dental Services See details
Wellcare Dual Reserve (HMO D-SNP) offers partially covered dental services with a $25 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and most comprehensive services. While many diagnostic, restorative, and surgical services are covered up to a $3,000 annual maximum, 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 D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Reserve (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with manufacturer limitations applying to diabetic services.
Diagnostic and Radiological Services See details
Wellcare Dual Reserve (HMO D-SNP) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic tests range from no copay to a $20 copay with no coinsurance, lab services and diagnostic radiology have no copay or coinsurance, while therapeutic radiology requires a minimum 20% coinsurance and outpatient X-rays have a $35 copay and coinsurance.
Home Health Services See details
Home health services are covered under Wellcare Dual Reserve (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Wellcare Dual Reserve (HMO D-SNP) with no copay and no coinsurance, though some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Reserve (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and days 41 through 100, while days 21 through 40 require a $218 daily copay, with additional days beyond the 100-day Medicare limit not covered.
Other Services See details
Wellcare Dual Reserve (HMO D-SNP) covers over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though a referral is required for meals. Other benefits within this category, including acupuncture and highly integrated services for dual-eligible SNPs, are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved