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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 All counties in TN. This plan received an overall rating of 3.5 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 $39.10. 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 costs for your drugs based on the tier and pharmacy you use, until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your Part D premium is $39.10. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan provides coverage for a wide range of services with varying costs. Inpatient hospital stays require a $1850 copay per admission, while emergency services have a $110 copay. Many services, including primary care, outpatient services, and vision care, have a 20% coinsurance. The plan offers some services with no copay, such as routine eye exams, hearing aid fittings, and home health services. Additional benefits include hearing and vision services, dental services, and home infusion services. This plan also provides coverage for skilled nursing facilities with a copay that varies depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. You will pay a copay of $1850 per admission or stay for Medicare-covered inpatient hospital stays; additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a 20% coinsurance and no copay, while observation services have a 20% coinsurance. Outpatient blood services have a 20% coinsurance. Individual and group sessions for outpatient substance abuse have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under 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, with prior authorization required. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $110, $45, and $110 respectively, with no coinsurance; Worldwide Emergency Transportation is not covered. The copays for Emergency Services and Urgently Needed Services are waived if admitted to the hospital within 24 hours.
Primary Care See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers primary care physician services with 20% coinsurance. Chiropractic services, including routine care, have no copay. Occupational therapy services, physician specialist services, physical therapy, and speech-language pathology services have 20% coinsurance. Mental health specialty services, including individual and group sessions, have a 20% coinsurance. Podiatry services and routine foot care have no copay. Other health care professional services and psychiatric services, including individual and group sessions, have a 20% coinsurance. Additional telehealth benefits have a coinsurance of 20% and a copay between $0 and $45. Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services and an annual physical exam with no copay, and other preventive services with a 20% coinsurance. Additional benefits like Personal Emergency Response System and Alternative Therapies have no copay.
Hearing Services See details
Hearing services include coverage for hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1500 per year with no copay for all types of prescription hearing aids, but inner, outer, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear benefits. Eye exams have a 20% coinsurance with no copay, and routine eye exams have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all have no copay.
Dental Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers Medicare Dental Services with 20% coinsurance, and other dental services including oral exams, dental x-rays, and cleanings with no copay. Orthodontic services are covered up to a maximum of $5000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Equipment has a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. For Diagnostic Procedures/Tests, the coinsurance is at most 20%, and for Lab Services, there is no copay and the coinsurance is at most 20%. Diagnostic Radiological Services have no copay and a coinsurance of at most 20%, while Therapeutic Radiological Services and Outpatient X-Ray Services have 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. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, with a prior authorization requirement. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF are not covered.
Other Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan's "Other Services" benefit covers Over-the-Counter (OTC) items and Meal Benefits. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. OTC items have no copay.
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