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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 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 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 $13.10. 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 $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 $7500.00 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 features an annual drug deductible of $615. Tier 6 Select Care drugs are highly affordable, offering no copay across all pharmacy and mail-order options. Standard and preferred generic drugs in Tiers 1 and 2 have low copays starting at $18 and $19, and you can enjoy no copay for a three-month supply when using a preferred mail-order service. For higher-tier medications, Tier 3 Preferred Brand drugs require a 21% coinsurance, while Tier 5 Specialty drugs have a 25% coinsurance for a one-month supply. Tier 4 Non-Preferred drugs require a $100 copay for a one-month supply at both preferred and standard pharmacies. These tier costs help you determine your potential out-of-pocket expenses under this Wellcare Medicare plan.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) offers comprehensive healthcare coverage with no copay for primary care visits, preventive care, and home health services. Specialist visits require a low $15 copay, while inpatient acute hospital stays feature a $400 copay for the first six days and no copay for days 7 through 120. Outpatient hospital services are covered with no coinsurance and a variable $0 to $300 copay depending on the service. This plan also includes extensive dental, vision, and hearing benefits with no copay and no coinsurance, including up to $3,000 annually for dental care and $1,000 per ear for hearing aids. Additionally, members enjoy valuable everyday perks like no-copay over-the-counter items and home-delivered meals to support overall health and wellness.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute care requires a $400 copay for days 1 through 6 and no copay for days 7 through 120, while psychiatric care has an $1,800 copay per stay, though upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $250 copay for ambulatory surgical center services. Outpatient substance abuse sessions carry a $25 copay, while outpatient blood services are provided with no copay.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers ground and air ambulance services with a $285 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum benefit with a $115 copay and no coinsurance, but 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 and podiatry require a $15 copay with no coinsurance. Mental health and psychiatric services have a $25 copay, physical and occupational therapies require a $10 copay, and telehealth copays range from $0 to $40, all with no coinsurance. Some chiropractic services are covered, but routine and other chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers preventive services, offering no copay and no coinsurance for annual physical exams, fitness benefits, alternative therapies, and glaucoma screenings. Kidney disease education is covered with no copay and a 20% coinsurance, while additional preventive services are only partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered by Wellcare Dual Reserve (HMO-POS D-SNP), featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 maximum per ear annually, excluding OTC, inner ear, outer ear, and over-the-ear hearing aids.
Vision Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) vision services are partially covered, offering one annual routine eye exam with no copay and no coinsurance, though other eye exam services are not covered. Covered eyewear benefits have no copay, no coinsurance, and no deductible up to a $200 annual maximum, with prior authorization required.
Dental Services See details
Dental services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), offering preventive and most comprehensive services with no copay and no coinsurance, up to a $3,000 yearly limit. Medicare-covered dental services require a $15 copay and no coinsurance, while implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance with no copay.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with no copay, though a 20% coinsurance applies to durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts. 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 Reserve (HMO-POS D-SNP) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $20 copay for diagnostic procedures, while radiological services range from no copay for diagnostic radiology to a 20% coinsurance for therapeutic radiology and a $50 copay for outpatient X-rays.
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. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers cardiac rehabilitation services with no coinsurance, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered, requiring copayments of $30, $40, $25, and $20, respectively.
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 61 to 100, and a $218 copay per day for days 21 to 60. This benefit is partially covered as prior authorization is required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance. Acupuncture is not covered, and a referral is required to access the meal benefit.
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