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Wellcare Dual Reserve (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (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 Reserve (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Reserve (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 Reserve (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 Reserve (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 Reserve (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 Reserve (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.40. 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 $4200.00 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-POS D-SNP) prescription drug plan has an annual deductible of $615. For Tier 6 select care drugs, you will pay no copay at standard, preferred, or mail-order pharmacies. Additionally, you can secure a three-month supply of Tier 1 preferred generics and Tier 2 generics with no copay when using preferred mail-order services. For brand-name and specialty medications, costs shift to coinsurance and copays, such as a 23% to 24% coinsurance for Tier 3 preferred brands. Tier 4 non-preferred drugs require a $100 copay for a one-month supply, while Tier 5 specialty drugs incur a 25% coinsurance. Choosing preferred pharmacies and mail-order options generally offers the lowest out-of-pocket costs for your prescriptions under this plan.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers robust medical coverage with no copay for primary care visits and a $25 copay for specialist consultations. Emergency room visits require a $150 copay, while inpatient hospital stays incur a $300 daily copay for the first seven days before transitioning to no copay for days eight through 90. Outpatient services are also highly accessible, featuring no coinsurance and outpatient hospital copays ranging from no copay up to $275. This plan also provides strong supplemental benefits, including no copay for routine dental, vision, and hearing exams, alongside generous annual allowances of $3,000 for dental care and $400 for eyewear. Members benefit from no copay on home health services and up to 12 free one-way transportation trips per year to plan-approved locations. Additionally, over-the-counter items are covered with no copay, while durable medical equipment is available with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $300 copayment for days 1 through 7 and no copayment for days 8 through 90 per admission for acute and psychiatric stays. Upgrades, additional days, and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers outpatient services with no coinsurance, featuring outpatient hospital copays from $0 to $275, observation services from $150 to $275 per stay, and ambulatory surgical center services at a $225 copay. Outpatient substance abuse services require a $25 copay per session with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Dual Reserve (HMO-POS D-SNP) with a $175.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers ground and air ambulance services with a $300 copay and no coinsurance. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, but trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with a $150 copay and no coinsurance, which is waived if admitted within 24 hours, and urgent care is covered with a $25 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy, and mental health services require a $25 copay and no coinsurance. Podiatry services are not covered, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers preventive services, offering annual physicals, screenings, and select supplemental benefits with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Supplemental benefits like PERS, alternative therapies, and in-home support require a referral but are available with no copay and no coinsurance. Sub-services such as health education, weight management, nutritional benefits, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Medicare-covered hearing exams for a $25 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $750 per ear yearly, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) vision services are partially covered, offering one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts, frames, lenses, and upgrades, also features no copay and no coinsurance up to a $400 annual maximum.
Dental Services See details
Dental services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), requiring a $25 copay and no coinsurance for Medicare-covered dental services, and no copay and no coinsurance for other preventive and comprehensive services up to a $3,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes and inserts, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers diagnostic tests with a copay of up to $25 and no coinsurance, while lab services have no copay and no coinsurance. Covered radiological services require prior authorization and feature a $50 copay and coinsurance for X-rays, diagnostic radiology with no minimum copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. While some services are covered, specific sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and days 41 to 100, and a $218 daily copay for days 21 to 40. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and highly integrated dual-eligible SNP services are not covered under this plan benefit.
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