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Wellpoint Full Dual Advantage (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Full Dual Advantage (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 Wellpoint Full Dual Advantage (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Wellpoint Full Dual Advantage (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Iowa. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellpoint Full Dual Advantage (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:
Wellpoint Full Dual Advantage (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 Wellpoint Full Dual Advantage (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 Wellpoint Full Dual Advantage (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $50.60. 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 Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay costs for your drugs, but the specific costs for each tier are not provided in this summary. Once your total drug costs reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), the plan's premium may be reduced. During the catastrophic coverage phase, after your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan offers a range of benefits with varying cost-sharing options. Many services have no copay, including preventive services like annual physical exams, hearing and vision services like routine eye exams and eyewear, and dental services like oral exams and dental x-rays. Other services, such as outpatient services, primary care, and diagnostic services, typically have a coinsurance of 20%. The plan also covers emergency services and ambulance services, with copays and coinsurance depending on the specific service. Additionally, this plan provides coverage for home health services with no copay, and offers over-the-counter items with no copay up to $140 per month. However, some services, such as cardiac rehabilitation and additional days for inpatient hospital stays, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days for inpatient hospital, and non-medicare covered stays are not covered. Both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric require prior authorization and have coinsurance costs, which are defined by Medicare.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay, and individual and group sessions for outpatient substance abuse have a minimum of 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan. The plan has a $55 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan. Both ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay, and Urgently Needed Services have a $20 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay, but Worldwide Emergency Services has a maximum plan benefit coverage of $100,000.
Primary Care See details
The Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, 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. Primary care physician services, chiropractic services, physician specialist services, and physical therapy and speech-language pathology services have a 20% coinsurance. Occupational therapy and additional telehealth benefits have no copay. Individual and group sessions for mental health and psychiatric services have a 20% coinsurance. Podiatry services have a 20% coinsurance for routine foot care, and Medicare-covered podiatry services have no copay. Other health care professional services and opioid treatment program services have a 20% coinsurance. Chiropractic services and podiatry services require prior authorization.
Preventive Services See details
Preventive Services include Medicare-covered services, with annual physical exams covered with no copay. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay, up to a maximum of $300 every year for both ears combined.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear has a 20% coinsurance; contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have no copay, and there is a $500 combined maximum for all eyewear every year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a $6,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a coinsurance of 0% to 20%, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and All Diagnostic services and All Radiological Services have no copay.
Home Health Services See details
Home Health Services are covered under the Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan. The plan does not cover 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, but the plan does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays. The plan requires prior authorization and charges the Medicare-defined cost share for tier 1.
Other Services See details
The Wellpoint Full Dual Advantage (HMO-POS D-SNP) plan covers over-the-counter items with no copay, and a maximum benefit coverage amount of $140 per month. 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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