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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 Select counties in SC. 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 $36.00. 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 you meet your deductible, you will pay the costs for your drugs. Once your total drug costs reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $36. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers a range of benefits with varying cost-sharing options. Inpatient hospital stays have a $1475 copay per admission, while emergency services cost $110. Many services, like preventive care, hearing exams, and routine dental services, have no copay, while others have a 20% coinsurance. The plan provides coverage for outpatient services, ambulance, and transportation, with a limit of 60 one-way trips per year. Other benefits include coverage for home health services with no copay, and prescription hearing aids with a maximum benefit. However, certain services like cardiac rehabilitation and additional inpatient hospital days are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan, with a copay of $1475 per admission or stay for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days, and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a 20% coinsurance and no copay, while Observation Services have a 20% coinsurance. Outpatient Blood Services have a 20% coinsurance, and the plan waives the three (3) pint deductible. Individual and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance.
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
The Wellcare Dual Access (HMO-POS D-SNP) plan covers ambulance services with a 20% coinsurance for both ground and air ambulance services, and transportation services with no copay. Transportation services to any health-related location are limited to 60 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage all have a copay of $110, $45, and $110 respectively, with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers primary care physician services with a 20% coinsurance. Chiropractic services are covered, with a 20% coinsurance for routine care and no copay for routine care.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with a copay for certain services. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered with 20% coinsurance.
Hearing Services See details
Hearing exams and prescription hearing aids are covered, with Routine Hearing Exams and Fitting/Evaluation for Hearing Aid services covered at no copay and no coinsurance. The plan has a maximum benefit of $2500 per year for prescription hearing aids. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including routine eye exams, eyewear, contact lenses, eyeglasses, and upgrades, are covered. Routine eye exams have a 20% coinsurance, but no copay, while all other vision services have no copay.
Dental Services See details
Dental services are covered, with 20% coinsurance for Medicare dental services. Other dental services include 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, all with no copay. Orthodontic services are covered with a $2,000 maximum benefit per year. 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan with no copay and no coinsurance. However, 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. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a $214 copay. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with no copay, and a limit of 36 treatments per year, and over-the-counter items with no copay. The meal benefit is covered with no copay, but requires a doctor referral. However, 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.
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