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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 2025, 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 out of 5 stars in 2025.
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 $35.10. 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-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the cost-sharing amounts for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, you may pay a reduced premium. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs. Please refer to the plan's formulary for specific drug costs.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a high copay, while outpatient services and many specialist visits have a 20% coinsurance. The plan covers many services with no copay, including home health, dental services, and preventive services like annual physical exams. Emergency services have a copay, and ambulance services have a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with a copay of $1990 per admission or stay, and additional days and non-Medicare-covered stays are not covered. Prior authorization is required.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a 20% coinsurance and no copay, and observation services with 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered, with a 20% coinsurance for Individual and Group Sessions. Outpatient Blood Services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to plan-approved health-related locations have no copay and are limited to 36 one-way trips per year. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services have a $45 copay; all three have no coinsurance. Worldwide Urgent Coverage has a $110 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers primary care physician services with a 20% coinsurance, chiropractic services with no copay, occupational therapy services with 20% coinsurance, and physician specialist services with a 20% coinsurance. The plan also covers mental health specialty services, psychiatric services, physical therapy and speech-language pathology services, and additional telehealth benefits with 20% coinsurance.
Preventive Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like glaucoma screenings, diabetes self-management training, and barium enemas are covered with 20% coinsurance.
Hearing Services See details
Hearing exams, including routine hearing exams, are covered with a 20% coinsurance for routine hearing exams and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids, with one routine hearing exam and one fitting/evaluation for hearing aid allowed per year. Prescription hearing aids are covered, but with a $2,000 maximum plan benefit coverage per year, and no copay for Prescription Hearing Aids (all types), but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers vision services, including eye exams with a 20% coinsurance and no copay. Eyewear is also covered, with a 20% coinsurance and a $0 copay, and a combined maximum benefit of $400.
Dental Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers Medicare Dental Services with 20% coinsurance. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, including Medicare Part B insulin drugs with a $35 copay. Other Medicare Part B drugs, including Chemotherapy/Radiation drugs, have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts all have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access (HMO-POS 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-POS D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 12 treatments per year. This plan also covers over-the-counter items, including nicotine replacement therapy and Naloxone, with no copay. Meal benefits are also covered with no copay. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more.
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