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Wellcare Dual Access (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (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 Wellcare Dual Access (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Statewide in OH. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Dual Access (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:
Wellcare Dual Access (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 Wellcare Dual Access (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 Wellcare Dual Access (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.40. 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 $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-POS D-SNP) plan features an annual drug deductible of $615. For lower-tier medications, Tier 1 preferred generics start at an $18 copay for a one-month supply at preferred pharmacies, while Tier 2 generics start at a $19 copay. Beneficiaries can also take advantage of no copay for a three-month supply of Tier 1 and Tier 2 drugs when using preferred mail order services. For higher-tier prescriptions, Tier 3 preferred brands require a 20% coinsurance at preferred pharmacies, and Tier 5 specialty drugs require a 25% coinsurance. Tier 4 non-preferred drugs carry a $100 copay for a one-month supply at both preferred and standard pharmacies. Notably, Tier 6 select care drugs are available with no copay across all pharmacy and mail order options.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers comprehensive medical coverage with no copays for most outpatient, primary care, specialist, and diagnostic services, though a 20% coinsurance typically applies. Inpatient hospital admissions require an $1,815 copayment per stay, while emergency room visits carry a $115 copay that is waived if you are admitted. Skilled nursing facility stays feature no copay for days 1 to 20 and days 71 to 100, but require a $218 daily copay for days 21 to 70. This plan also includes valuable supplemental benefits like preventive dental care, home health services, and fitness programs with no copays or coinsurance. Additionally, members benefit from routine hearing and vision care, which feature no copays alongside annual allowances for hearing aids and eyewear. Other helpful extras include up to 12 one-way transportation trips per year and over-the-counter item reimbursements at no cost.
Inpatient Hospital See details
Wellcare Dual Access (HMO-POS D-SNP) offers partially covered inpatient hospital services, which require a $1,815 copayment per admission and no coinsurance for both acute and psychiatric stays. Prior authorization is required, and sub-services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for select services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance, providing up to 12 one-way trips per year to plan-approved health-related locations, though trips to any health-related location are not covered.
Emergency Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access (HMO-POS D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance, while chiropractic services are not covered. Routine podiatry is covered with no copay and no coinsurance for up to 6 visits per year, and additional telehealth benefits carry a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers partially covered preventive services, including an annual physical exam with no copay and no coinsurance, alongside kidney education and other screenings with no copay and a 20% coinsurance. Additional benefits like fitness and personal emergency response systems are covered with no copay and no coinsurance, though sub-services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers hearing services with no deductible, offering routine hearing exams for a 20% coinsurance and no copay, alongside fitting evaluations with no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), offering one routine eye exam yearly and eyewear up to a $400 annual limit with no deductibles and prior authorization required. Routine exams and contact lenses have no copay but require a 20% coinsurance, while eyeglasses, frames, lenses, and upgrades have no copay or coinsurance; other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), offering Medicare-covered dental services with no copay and a 20% coinsurance, and other preventive and comprehensive dental services with no copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and prior authorization is required for most covered services.
Home Infusion bundled Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic supplies. Prior authorization is required for these covered services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, with prior authorization required. Covered services include diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers a cardiac rehabilitation benefit where some services are covered with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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-POS D-SNP) with no coinsurance, featuring no copay for days 1 to 20 and days 71 to 100, and a $218 copay per day for days 21 to 70. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers partial coverage for other services, which includes over-the-counter (OTC) items with no copay and no coinsurance through a reimbursement model. Acupuncture, meal benefits, and highly integrated dual-eligible SNP services are not covered under this plan.
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