A non-government entity
Wellcare Dual Reserve (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (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 Reserve (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Reserve (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 MO. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Dual Reserve (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 Reserve (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 Reserve (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 Reserve (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.60. 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 $3600.00 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:
Sign up for Wellcare Dual Reserve (HMO-POS D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Dual Reserve (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, 1-month copays start as low as $18 and $19 at preferred pharmacies, with no copay required for 3-month supplies filled through preferred mail order. Tier 6 select care drugs offer the most affordable coverage with no copay at preferred pharmacies and through preferred mail order. For higher-tier medications, Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance. Tier 4 non-preferred drugs have a $100 copay for a 1-month supply at both preferred and standard pharmacies. Standard pharmacies and standard mail order services are also available but generally feature slightly higher copays for your prescriptions.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers comprehensive medical coverage designed to keep out-of-pocket costs low, featuring no copay for primary care visits, home health services, and routine preventive care. Specialist visits and outpatient mental health services require a $25 copay, while outpatient hospital care ranges from no copay up to a $250 copay. Emergency room visits carry a $150 copay, which is waived if you are admitted, and inpatient hospital stays require daily copays for only the first eight days. In addition to medical care, the plan provides robust dental, vision, and hearing benefits with no copay for routine exams, alongside allowances of up to $300 for eyewear and $500 per ear for prescription hearing aids. Members also receive no-copay transportation for up to 36 one-way trips per year to plan-approved locations. Durable medical equipment, prosthetics, and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a daily copay of $290 for acute stays and $250 for psychiatric stays during days 1 through 8, followed by no copay for days 9 through 90. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers outpatient services with no coinsurance, including outpatient hospital visits with copays ranging from $0 to $250 and ambulatory surgical center services with a $200 copay. Outpatient substance abuse services require a $25 copay per session with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers partial hospitalization with a $175.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers ground and air ambulance services with a $250 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers emergency services with a $150 copay and no coinsurance, and urgent care with a $35 copay and no coinsurance, with both copays waived if admitted within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum limit with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO-POS D-SNP) features primary care physician services with no copay and no coinsurance, though chiropractic services are not covered. Most specialist, therapy, podiatry, and mental health services require a $25 copay and no coinsurance, while telehealth benefits are available with a $0 to $35 copay and no coinsurance.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams, fitness programs, and alternative therapies, while kidney disease education has no copay but a 20% coinsurance. Additional preventive benefits are only partially covered, excluding services such as health education, medical nutrition therapy, in-home safety assessments, and nutritional or dietary benefits.
Hearing Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) offers partially covered hearing services, including Medicare-covered exams for a $25 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) vision services are partially covered, featuring no coinsurance and copays ranging from $0 to $25 for eye exams, though other eye exam services are not covered. Routine eye exams and eyewear—including contact lenses and eyeglasses—are available with no copay and no coinsurance, with eyewear subject to a $300 annual maximum benefit.
Dental Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) offers partially covered dental services, featuring a $25 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for most preventive and comprehensive services. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with prior authorization, featuring no copay for lab services and diagnostic radiology. Diagnostic tests and procedures have no coinsurance and a $0 to $30 copay, while outpatient X-rays require a $50 copay and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
Home health services are covered under Wellcare Dual Reserve (HMO-POS D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) offers Cardiac Rehabilitation Services with no coinsurance, but only some services are covered. Standard cardiac rehabilitation (which carries a $50 copay), intensive cardiac rehabilitation ($65 copay), pulmonary rehabilitation ($40 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($30 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no coinsurance and require prior authorization. There is no copay for days 1 to 20 and days 41 to 100, a $218 daily copay applies for days 21 to 40, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under the Wellcare Dual Reserve (HMO-POS D-SNP) are partially covered, offering over-the-counter (OTC) items and limited meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered, and a referral is required to receive the covered meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved