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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 2026, 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 out of 5 stars in 2026.
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 $24.20. 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 Wellcare Dual Access (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615. You will pay no copay for Tier 6 select care drugs across all pharmacy and mail-order options. Tier 1 preferred generic drugs start at a $7 copay at preferred pharmacies, while Tier 2 generic drugs start at a $19 copay, with both tiers offering no copay for three-month supplies filled through preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 5 specialty drugs carry 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. Utilizing preferred pharmacies and mail-order services helps maximize your savings under this plan.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers comprehensive medical coverage, featuring an inpatient hospital stay copayment of $1,850 and no coinsurance. Many outpatient services, doctor visits, and diagnostic tests are available with no copay and a 20% coinsurance. Emergency care requires a $115 copay, which is waived if you are admitted, while urgently needed care carries a $40 copay. For everyday wellness, the plan provides preventive care, routine dental services, and home health care with no copay and no coinsurance. Vision and hearing benefits feature no copays, though some services require a 20% coinsurance, with allowances of up to $1,500 per ear for hearing aids and $300 annually for eyeglasses. Members also benefit from no copay on up to 60 one-way transportation trips per year and no copays for the first 20 days of skilled nursing facility stays.
Inpatient Hospital See details
Wellcare Dual Access (HMO-POS D-SNP) partially covers inpatient acute and psychiatric hospital services with a $1,850 copayment per stay, no coinsurance, and prior authorization requirements. This benefit does not cover upgrades, additional days, or non-Medicare-covered stays.
Outpatient Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Wellcare Dual Access (HMO-POS D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Dual Access (HMO-POS D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 60 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 Access (HMO-POS D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access (HMO-POS D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and a 20% coinsurance, while routine podiatry includes no copay and no coinsurance. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and no coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams, and no copay for fitness, alternative therapies, and in-home support. The benefit is partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling. Kidney disease education and select screenings are covered with no copay and a 20% coinsurance.
Hearing Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers hearing services with no deductible, offering annual routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,500 per ear annually, though OTC hearing aids, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Dual Access (HMO-POS D-SNP) vision services are partially covered because other eye exam services are not covered. Routine eye exams (limited to one per year) and contact lenses have no copay but require a 20% coinsurance, while eyeglasses and upgrades are covered with no copay or coinsurance up to a $300 annual limit with no deductible.
Dental Services See details
Dental services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental care, and no copay or coinsurance for covered preventive and comprehensive services. While most diagnostic, preventive, and restorative treatments are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay, though prior authorization and step therapy may be required. Under this benefit, Medicare Part B chemotherapy and other drugs have a coinsurance ranging from 0% to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access (HMO-POS D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, though prior authorization is required. These covered benefits include lab services, diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Wellcare Dual Access (HMO-POS D-SNP) with no copay; however, while some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1-20 and 71-100, and a $218 daily copay for days 21-70. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Wellcare Dual Access (HMO-POS D-SNP) partially covers other services, offering over-the-counter (OTC) items and a meal benefit for chronic illness with no copay and no coinsurance. Acupuncture is not covered under this plan.
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