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Wellpoint Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Full Dual Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Full Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellpoint Full Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2026 to people living in Select Counties in West Virginia. The overall rating for this plan is not yet available for 2026.
It's important to know that Wellpoint Full Dual Advantage (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:
Wellpoint Full Dual Advantage (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 Wellpoint Full Dual Advantage (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 Wellpoint Full Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 Wellpoint Full Dual Advantage (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order. This no-cost coverage applies to one-month, two-month, and three-month supply options. For other medication categories, you will pay a 25% coinsurance for Tier 2 generic drugs, Tier 3 preferred brand drugs, and Tier 4 non-preferred drugs. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply at standard pharmacies or through standard mail order.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers comprehensive coverage with no copay for inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient care, specialist visits, and diagnostic services, members will generally face no copay but must pay a 20% coinsurance. Emergency care is available with a $115 copay, while urgent care requires a $20 copay, both with no coinsurance. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay or coinsurance up to a $2,500 annual limit. Additionally, members can access routine vision and hearing services with no copay and generous allowances for eyewear and hearing aids. Other perks like over-the-counter items, fitness programs, and routine transportation are also covered with no copay or coinsurance.
Inpatient Hospital See details
Wellpoint Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric stays with no copay and no coinsurance, though prior authorization is required. Sub-services such as additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Wellpoint Full Dual Advantage (HMO D-SNP) with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services are partially covered with no copay and no coinsurance for up to 42 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and 20% coinsurance, while telehealth is offered with no copay and no coinsurance. Chiropractic benefits are partially covered, offering up to 48 routine visits per year with no copay and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Wellpoint Full Dual Advantage (HMO D-SNP) are partially covered, offering no copay and no coinsurance for annual physical exams, kidney disease education, and select supplemental benefits like fitness and personal emergency response systems. A 20% coinsurance applies to glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs following a welcome visit, while several sub-services like health education, nutritional therapy, and in-home safety assessments are not covered.
Hearing Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers hearing services with no deductible, including an annual routine exam for a 20% coinsurance and no copay, and a yearly fitting evaluation with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $3,000 annual limit, though inner ear, outer ear, and over the ear models are not covered, while OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) vision services are partially covered, providing one routine eye exam per year with no copay and 20% coinsurance, though prior authorization is required and other eye exam services are not covered. Eyewear is covered up to a $300 annual limit with no deductible, offering contact lenses with no copay and 20% coinsurance, and eyeglasses with no copay or coinsurance, while upgrades are not covered.
Dental Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) offers partially covered dental services, which exclude maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services are available with no copay and a 20% coinsurance, while other covered preventive and comprehensive services feature no copay and no coinsurance up to a $2,500 annual maximum.
Home Infusion bundled Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Wellpoint Full Dual Advantage (HMO D-SNP) with no copay for durable medical equipment (DME), prosthetics, and diabetic supplies. While diabetic equipment features no coinsurance, DME requires 0% to 20% coinsurance, and Medicare-covered prosthetics and medical supplies carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic procedures, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization required, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay or coinsurance, and prior authorization is required. The benefit is partially covered as additional days beyond the Medicare-covered limit are not covered, though admission does not require a prior three-day inpatient hospital stay.
Other Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) partially covers other services, offering over-the-counter items, chronic illness meal benefits, and Medicare community resource support with no copay and no coinsurance. Acupuncture is not covered under this plan.
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