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Wellpoint Dual Advantage (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint 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 Dual Advantage (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Wellpoint 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 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 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 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 Dual Advantage (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $6.80. 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 $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 $4151.00 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 Dual Advantage (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After you meet the deductible, you'll pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000. Once you have spent $2000, you enter the next coverage phase where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), also known as "Extra Help", your monthly premium for Part D drugs will be $6.80. Please check the plan's formulary for specific drugs covered.
Additional Benefits
The Wellpoint Dual Advantage (HMO-POS D-SNP) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0-$295. The plan includes coverage for ambulance and transportation services, along with emergency and primary care services, often with no copay. Preventive services, vision, hearing, and dental services are covered, with some services having no copay. Additional benefits include home health, medical equipment, and home infusion services, each with varying cost structures. The plan also covers skilled nursing facility stays with a copay after the initial 20 days, and offers additional benefits such as OTC items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $295 for days 1-5 and no copay for days 6-90. Additional days for both are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $295, observation services with a $295 copay, and Ambulatory Surgical Center (ASC) services with no copay. Outpatient substance abuse services have a $30 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Dual Advantage (HMO-POS D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
The Wellpoint Dual Advantage (HMO-POS D-SNP) plan covers ambulance services with a $280 copay for both ground and air ambulance services, with no coinsurance. Transportation services to plan-approved health-related locations are covered with no copay, with a limit of 84 one-way trips per year, and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Dual Advantage (HMO-POS D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $20 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a $20 copay, but routine care is not covered. Occupational Therapy Services have a $30 copay. Physician Specialist Services have a $30 copay. Mental Health Specialty Services have a $30 copay for individual and group sessions. Podiatry Services have a copay that ranges from $0 to $30. Other Health Care Professional services have a copay between $0 and $20. Psychiatric Services have a $30 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $30 copay. Additional Telehealth Benefits are covered with no copay. Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive Services, including Medicare-covered zero dollar services, are covered. Annual physical exams have no copay. Additional preventive services are covered, and some services, like health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services, are not covered. Fitness benefits, Personal Emergency Response Systems (PERS), Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, and coverage for routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a plan-specified amount per year, and OTC hearing aids are covered with no copay up to $300 every year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Wellpoint Dual Advantage (HMO-POS D-SNP) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with a $0 copay and a combined maximum benefit of $250 per year. Routine eye exams are covered with no copay, and other eyewear benefits such as contact lenses, eyeglass lenses and frames are covered with no copay.
Dental Services See details
Wellpoint Dual Advantage (HMO-POS D-SNP) covers many dental services, including oral exams, dental x-rays, and cleanings, with no copay. The plan also covers restorative services with a $0 copay, limited to 1 filling per tooth every 3 years and 1 crown per tooth every 5 years.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Dual Advantage (HMO-POS D-SNP) plan. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment with no copay and 0-20% coinsurance, prosthetics/medical supplies with no copay and 20% coinsurance, and diabetic equipment with no copay. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with copays ranging from $0 to $25, and lab services with no copay. Diagnostic radiological services have a copay of at most $245, while therapeutic radiological services have a coinsurance of at most 20%. Outpatient X-ray services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Wellpoint 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 covered by the Wellpoint Dual Advantage (HMO-POS D-SNP) plan, but the specific services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Dual Advantage (HMO-POS D-SNP) plan, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellpoint Dual Advantage (HMO-POS D-SNP) plan covers Over-the-Counter (OTC) items and Meal Benefits with no copay, and also covers other services such as Medicare Community Resource Support with no copay. 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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