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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 2025, 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 3.5 out of 5 stars in 2025.
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 $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 $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:
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Drug Coverage
The Wellcare Dual Reserve (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier, pharmacy, and day supply, until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), your monthly premium may be reduced to $18.30.
Additional Benefits
The Wellcare Dual Reserve (HMO D-SNP) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, but outpatient services can range from no copay to $250. Many services have no copay, including primary care, preventive services, and dental services. Other key benefits include coverage for hearing and vision services, with copays for hearing exams and eye exams, and varying coverage for eyewear and hearing aids. The plan also includes coverage for ambulance and transportation services, emergency services, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $200 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $250, observation services with a copay between $140 and $250, ambulatory surgical center services with a $150 copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay. Outpatient blood services include three pints with a waived deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Dual Reserve (HMO D-SNP) plan, but requires prior authorization. You will pay a $130 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $250 copay, and transportation services to a plan-approved health-related location have no copay, with a limit of 60 one-way trips per year via rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140, $25, and $140, respectively, with no coinsurance. Worldwide Urgent Coverage also has a copay of $140, and Worldwide Emergency Transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO D-SNP) covers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist, mental health specialty, and psychiatric services with a $25 copay, and physical therapy and speech-language pathology services with a $25 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, as well as additional preventive services with varying copays depending on the service. Other covered services include Glaucoma screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $25 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $1,500 per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Wellcare Dual Reserve (HMO D-SNP) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with no copay. Eyewear benefits have a combined maximum of $200 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, and other services like oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Orthodontic services are covered up to a maximum of $3000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Dual Reserve (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Reserve (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with a 20% coinsurance and requiring prior authorization. Prosthetics and Medical Supplies are covered with a 20% coinsurance, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $20, lab services with no copay, diagnostic radiological services with a copay up to $100, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-ray services with a $35 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Reserve (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 covered by the Wellcare Dual Reserve (HMO D-SNP). However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Reserve (HMO D-SNP) plan, with prior authorization required. There is no copay for days 1-20 and days 51-100, but there is a $214 copay for days 21-50; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Wellcare Dual Reserve (HMO D-SNP) plan covers Over-the-Counter (OTC) items and Meal Benefits with no copay; however, acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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