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Wellcare Dual Access (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (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 Access (HMO D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Access (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 FL. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Dual Access (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 Access (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 Access (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 Access (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.50. 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 Wellcare Dual Access (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay costs for your drugs. The plan's formulary will have specific details on the cost-sharing for each drug. If you qualify for the low-income subsidy, you will pay $17.50 per month for Part D. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Dual Access (HMO D-SNP) plan offers comprehensive coverage, including inpatient hospital stays with a high copay, and outpatient services with coinsurance or no copay. You'll find coverage for emergency and urgent care, primary care with no copay, and various therapies and specialist services, often with 20% coinsurance. The plan also includes preventive services, such as an annual physical exam, and offers benefits for hearing, vision, and dental care, with varying costs. Additional benefits of this plan include coverage for ambulance services and transportation, home health services, and medical equipment. It also covers skilled nursing facility stays, and offers over-the-counter items and a meal benefit with no copay. However, it's important to note that some services, like cardiac rehabilitation, podiatry, and certain therapies, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor's referral, with a copay of $2,070 and $2,036 respectively per admission or stay. Additional days for Inpatient Hospital-Acute and Psychiatric, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services have a 20% coinsurance and no copay, while Observation Services have a 20% coinsurance. The plan also covers Individual and Group Sessions for Outpatient Substance Abuse, and Outpatient Blood Services with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access (HMO D-SNP) plan, but requires prior authorization and a doctor's referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Wellcare Dual Access (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all have no coinsurance. Worldwide Urgent Coverage has a $110 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with 20% coinsurance, and routine chiropractic care has no copay. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with 20% coinsurance. Mental Health Specialty Services and Psychiatric Services are covered with 20% coinsurance for individual and group sessions. Other Health Care Professional services have 20% coinsurance and no copay, while Additional Telehealth Benefits have 20% coinsurance with a copay between $0 and $45. Opioid Treatment Program Services are covered with 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for an annual physical exam with no copay, while other services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, 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, Telemonitoring Services, and Counseling Services are not covered. This plan also covers services such as Personal Emergency Response System (PERS), Alternative Therapies, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices 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
The Wellcare Dual Access (HMO D-SNP) plan covers hearing exams with a coinsurance of at most 20%, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a maximum benefit of $1,500 per year. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear, with a 20% coinsurance for eye exams and eyewear. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum plan benefit coverage amount of $400 per year.
Dental Services See details
The Wellcare Dual Access (HMO D-SNP) plan covers Medicare Dental Services with a 20% coinsurance. 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 are covered with no copay, but some have visit limits and periodicity restrictions. Orthodontic services are covered up to a $5,000 annual maximum, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but 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 ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access (HMO D-SNP) plan. This benefit requires a doctor referral and has a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Dual Access (HMO D-SNP) plan, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for Medicare-covered Diabetic Supplies and Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services, are covered. For diagnostic procedures/tests, and radiological services, you pay at most 20% coinsurance, while lab services have no copay and at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access (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 not covered by the Wellcare Dual Access (HMO D-SNP) plan. 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 Access (HMO D-SNP) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Dual Access (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay, and a meal benefit with no copay that requires a doctor referral. 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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