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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 Select counties in GA. This plan received an overall rating of 3.5 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 $23.50. 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 $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) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 6 Select Care Drugs are highly accessible with no copay across all retail pharmacies and mail-order services. For Tier 1 Preferred Generic and Tier 2 Generic medications, copays start as low as $18 and $19 respectively for a one-month supply, and both tiers offer no copay for three-month supplies filled through preferred mail order. For higher-tier medications, costs are structured around fixed copays and coinsurance. Tier 3 Preferred Brand drugs require a 20% coinsurance across all pharmacy types, while Tier 4 Non-Preferred Drugs have a $100 copay for a one-month supply. Tier 5 Specialty Tier drugs require a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers comprehensive coverage with many services requiring no copay, though a 20% coinsurance applies to outpatient services, specialist visits, and diagnostic tests. Inpatient hospital stays require a copayment of $2,170 for acute care or $2,080 for psychiatric care per stay, with no coinsurance. Emergency room visits have a $115 copay, while urgent care visits require a $40 copay. This plan also features valuable supplemental benefits with no copay or coinsurance, including home health services, up to 24 one-way transportation trips, and acupuncture. Additionally, members can access routine dental care up to a $4,000 annual limit and prescription hearing aids up to $1,000 per year with no copay or coinsurance. Routine eye exams and eyewear are also covered with no copay, though a 20% coinsurance applies and eyewear is capped at $400 annually.
Inpatient Hospital See details
Wellcare Dual Access (HMO-POS D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,170 copayment per stay for acute care and a $2,080 copayment per stay for psychiatric care. Prior authorization is required, and certain services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and substance abuse 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, and prior authorization is required.
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, subject to prior authorization. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Wellcare Dual Access (HMO-POS D-SNP) with a $115 copay and no coinsurance (waived if admitted within 24 hours), and urgent care is covered with a $40 copay and no coinsurance. 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
Primary care and specialist services under Wellcare Dual Access (HMO-POS D-SNP) are generally covered with no copay and a 20% coinsurance, though podiatry is not covered and chiropractic care is only partially covered, excluding other chiropractic services. Routine chiropractic care offers up to 12 visits per year with no copay and no coinsurance, while telehealth options are available with a $0.00 to $40.00 copay and 20% coinsurance.
Preventive Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers annual physical exams, fitness programs, alternative therapies, PERS, and remote access technologies with no copay and no coinsurance, while kidney education and select screenings require a 20% coinsurance and no copay. Additional preventive services are only partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers hearing services, featuring one routine hearing exam per year with a 20% coinsurance and no copay, and one fitting evaluation with no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per year, though OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), featuring no copay for one annual routine eye exam and eyewear, though a 20% coinsurance and prior authorization apply to routine exams and contact lenses. There is no deductible, other eye exam services are not covered, and eyewear is subject to a combined maximum benefit of $400 per year.
Dental Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers partially covered dental services, featuring Medicare-covered dental care with no copay and 20% coinsurance, and other preventive and comprehensive dental services with no copay and no coinsurance up to a $4,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
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. Associated Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access (HMO-POS D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay, subject to prior authorization and a 20% coinsurance. Covered services under this benefit include outpatient diagnostic procedures, lab services, X-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Wellcare Dual Access (HMO-POS D-SNP) are offered with no copay, but only some services are covered because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services 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 and do not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and days 71 through 100, while days 21 through 70 require a $218 daily copay, with additional days beyond the standard 100 days not covered.
Other Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers partially covered other services, including acupuncture (up to 12 treatments yearly), over-the-counter items, and meals for chronic or medical conditions with no copay and no coinsurance. While prior authorization is required for acupuncture and a referral is needed for meals, other supplemental services (Other 1, 2, and 3) and Dual Eligible SNPs with Highly Integrated Services are not covered.
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