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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 2025, 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 out of 5 stars in 2025.
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 $33.50. 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 $4700.00 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) plan has a $590 deductible for prescription drugs. Once the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2,000. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $33.50.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient hospital stays with a copay, outpatient services with copays ranging from $0-$300, and emergency services with a $125 copay. You'll also find coverage for primary care with no copay, along with preventive, hearing, vision, and dental services, each with specific copays or no copay. Additional benefits include ambulance and transportation services, home health services with no copay, and prescription hearing aids with a yearly allowance. However, it's important to note that some services, like cardiac rehabilitation and additional hours of care, are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute care with a copay of $325 for days 1-7, and no copay for days 8-90, plus 30 additional days at no copay. Inpatient Hospital Psychiatric services are covered with a $1,800 copay per admission or stay, and non-Medicare-covered stays and upgrades for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $300, Observation Services with a copay between $125 and $300, Ambulatory Surgical Center (ASC) Services with a $250 copay, Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Ground and air ambulance services have a copay of $285, with no coinsurance, and transportation services to a plan-approved health-related location have no copay and no coinsurance for up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $25 copay; there is no coinsurance for either. Worldwide Emergency Transportation is not covered, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay.
Primary Care See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers primary care physician services with no copay. Chiropractic services have a $10 copay, but routine care is not covered. Occupational therapy, physician specialist, physical therapy and speech-language pathology services all have a $10 copay. Mental health specialty services, psychiatric services, and podiatry services have a $10-$25 copay depending on the service. Other Health Care Professional services have a $0-$10 copay. Additional telehealth benefits have a $0-$25 copay. Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Personal Emergency Response System (PERS), Alternative Therapies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers hearing exams with a $10 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a plan-specified amount of $1500 per year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered, including routine eye exams and eyewear. Routine eye exams have no copay, and other eye exams have a copay between $0 and $10. Eyewear, contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a combined maximum plan benefit coverage of $200 for all eyewear, per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $10 copay, and 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 with no copay. Orthodontic Services are covered up to a maximum of $3,000 per year, while Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B drugs with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment including Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $20, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Reserve (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 Reserve (HMO-POS D-SNP) plan. Some services such as Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. For days 1-20, there is no copay; for days 21-60, the copay is $214, and for days 61-100, there is no copay. Additional days beyond Medicare-covered, and non-Medicare-covered stays, are not covered.
Other Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers over-the-counter items and meal benefits. Over-the-counter items have no copay, while meal benefits also have no copay and require a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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