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Wellpoint Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint 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 Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellpoint 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 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 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 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 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 $5400.00 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 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 filled at standard pharmacies or through standard mail order. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for one-, two-, or three-month supplies. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply at standard retail locations or through mail order.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) plan offers robust coverage with no copay for primary care visits, telehealth, routine preventive services, and home health care. Members also benefit from comprehensive dental coverage with no copays up to a $1,500 annual limit, alongside no-copay routine eye and hearing exams. Additionally, the plan provides allowances of up to $225 for eyewear and up to $2,500 for prescription hearing aids with no copays or coinsurance. For specialized care, specialist visits require a $25 copay, while inpatient hospital stays feature a $295 copay for the first seven days and no copay for subsequent days. Emergency room visits carry a $130 copay, though the plan includes up to 18 free one-way transportation trips per year to approved locations. Other valuable perks include no-copay over-the-counter items, chronic illness meals, and fully covered diabetic supplies.
Inpatient Hospital See details
Wellpoint Dual Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. Covered stays require a $295 copay for days 1 through 7 and no copay for days 8 and beyond, but upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers outpatient hospital services with no coinsurance and a copay of $0 to $295, and observation services with a $295 copay per stay and no coinsurance. Ambulatory surgical center, outpatient blood services, and outpatient substance abuse sessions are also covered with no coinsurance, featuring no copay for surgical and blood services and a $25 copay for substance abuse sessions.
Partial Hospitalization See details
Wellpoint Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a $260 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 18 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Wellpoint Dual Advantage (HMO D-SNP) with a $130 copay and no coinsurance, while urgently needed services require a $20 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum benefit limit of $100,000.
Primary Care See details
Wellpoint Dual Advantage (HMO D-SNP) features primary care and telehealth services with no copay and no coinsurance, though chiropractic services are not covered. Specialist visits, mental health sessions, and physical therapy require a $25 copay and no coinsurance, while podiatry services have a copay of $0 to $25 and no coinsurance.
Preventive Services See details
Wellpoint Dual Advantage (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and select safety devices. However, several additional preventive services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling services.
Hearing Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers routine hearing exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $25 copay and no coinsurance. OTC hearing aids are covered with no copay or coinsurance up to $300 annually, and prescription hearing aids are partially covered with no copay or coinsurance up to $2,500 annually, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Wellpoint Dual Advantage (HMO D-SNP) offers partially covered vision services with no deductibles and no coinsurance, featuring no copay for one routine eye exam per year and up to $225 annually for eyewear. Other eye exam services and eyewear upgrades are not covered, and prior authorization is required for eye exams.
Dental Services See details
Wellpoint Dual Advantage (HMO D-SNP) partially covers dental services with no copays and no coinsurance up to a $1,500 annual maximum benefit. While preventive, restorative, and surgical treatments are covered, implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Dual Advantage (HMO D-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are fully covered with no copay and no coinsurance, though prior authorization or manufacturer limitations may apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Wellpoint Dual Advantage (HMO D-SNP) with prior authorization, featuring no coinsurance and no copay for lab services, and a $0 to $85 copay for diagnostic tests. Outpatient x-rays require a $50 copay, while diagnostic radiological services carry a minimum $30 copay and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellpoint Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no coinsurance and no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other services are partially covered by Wellpoint Dual Advantage (HMO D-SNP), featuring no copay and no coinsurance for over-the-counter (OTC) items, chronic illness meal benefits, and Medicare Community Resource Support. Acupuncture is not covered under this plan.
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