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Wellcare Dual Reserve (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (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 Reserve (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Reserve (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 4 out of 5 stars in 2026.
It's important to know that Wellcare Dual Reserve (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 Reserve (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 Reserve (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 Reserve (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $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 $3000.00 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 D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, you will pay a low copay of $2 per month at preferred pharmacies, while Tier 2 generics carry a $19 preferred pharmacy copay. Notably, you can receive a three-month supply of both Tier 1 and Tier 2 drugs with no copay when using preferred mail-order services. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs have a $100 copay per month at both standard and preferred pharmacies. Tier 5 specialty drugs incur a 25% coinsurance for a one-month supply. Finally, Tier 6 select care drugs are fully covered with no copay across all standard and preferred pharmacies and mail-order options.
Additional Benefits
The Wellcare Dual Reserve (HMO D-SNP) plan offers comprehensive coverage with no copay and no coinsurance for many essential services, including inpatient hospital stays up to 90 days, primary care, specialist visits, and home health care. Outpatient services and diagnostic tests also feature no copays or coinsurance, although emergency room visits and ambulance rides require a $150 copay. Skilled nursing facility stays are covered with no copay for days 1 to 20 and days 41 to 100, though a $218 daily copay applies for days 21 to 40. For extra benefits, members enjoy dental, vision, and hearing services with no copays or coinsurance, which includes a $5,000 comprehensive dental limit and a $400 eyewear allowance. Standard medical and diabetic supplies are available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Additional perks like over-the-counter items and up to 12 one-way transportation trips per year are also provided with no copay or coinsurance.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO D-SNP) offers partially covered inpatient hospital services for acute and psychiatric care with no copay and no coinsurance for Medicare-covered stays up to 90 days. Prior authorization and referrals are required, and additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Wellcare Dual Reserve (HMO D-SNP) covers outpatient hospital services with no coinsurance and a copay of $0 to $225, while observation services require a $150 to $225 copay per stay with no coinsurance. Ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services are fully covered with no copays and no coinsurance.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO D-SNP) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Dual Reserve (HMO D-SNP), featuring a $150 copay and no coinsurance for both ground and air ambulance rides. The plan also includes up to 12 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Reserve (HMO D-SNP) covers emergency services with a $150 copay (waived if admitted within 24 hours) and urgently needed services with no copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO D-SNP) covers primary care, specialist visits, physical and occupational therapy, mental health, and telehealth services with no copay and no coinsurance. Chiropractic services are partially covered with no copay and no coinsurance for up to 12 routine visits per year, while other chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under the Wellcare Dual Reserve (HMO D-SNP) plan are partially covered, offering annual physicals, fitness benefits, alternative therapies, remote access, and select screenings with no copay and no coinsurance, alongside kidney disease education with no copay and 20% coinsurance. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Dual Reserve (HMO D-SNP), offering routine exams, fittings, and prescription hearing aids with no copay and no coinsurance, up to a $1,000 maximum benefit per ear every year. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Wellcare Dual Reserve (HMO D-SNP) vision services are partially covered, offering no copays, coinsurance, or deductibles for covered benefits, though prior authorization is required. Covered benefits include one routine eye exam per year (other eye exam services are not covered) and a $400 annual maximum allowance for eyewear, including contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Wellcare Dual Reserve (HMO D-SNP) with no copay and no coinsurance for covered preventive and comprehensive care, though prior authorization is required. While there is a $5,000 annual maximum for comprehensive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Dual Reserve (HMO D-SNP) with no copay and no coinsurance, subject to prior authorization. Under this plan, Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered by Wellcare Dual Reserve (HMO D-SNP) with no copay and a 20% coinsurance, though a referral is required.
Medical Equipment See details
Wellcare Dual Reserve (HMO D-SNP) covers medical equipment with no copay, though a 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay, and prior authorization is required for most equipment and supplies.
Diagnostic and Radiological Services See details
Wellcare Dual Reserve (HMO D-SNP) covers diagnostic tests, lab work, and diagnostic radiology with no copay and no coinsurance. Outpatient X-rays require a $40 copay, while therapeutic radiological services are subject to a 20% coinsurance, with prior authorization and referrals required for these services.
Home Health Services See details
Home health services are covered by Wellcare Dual Reserve (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Wellcare Dual Reserve (HMO D-SNP) covers cardiac rehabilitation services with no coinsurance and a required referral, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry copayments ranging from $30 to $65.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Reserve (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 to 20 and days 41 to 100, a $218 daily copay for days 21 to 40, and additional days beyond the standard 100 days are not covered.
Other Services See details
Wellcare Dual Reserve (HMO D-SNP) partially covers Other Services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though a referral is required for meals. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other miscellaneous services are not covered.
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