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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 IA. This plan received an overall rating of 2.5 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 $38.60. 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 $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 meeting the deductible, you'll pay the costs for your medications based on the drug tier until your total drug costs reach $2,000. Once your yearly out-of-pocket drug costs reach $2,000, you will enter the catastrophic coverage phase and pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, which is $38.60.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers a range of benefits. Inpatient hospital stays require a $1835 copay per admission, while outpatient services have a 20% coinsurance. Emergency services have a $110 copay, and urgent care has a $45 copay. This plan covers primary care, hearing and vision exams, dental services, and home health services with varying coinsurance rates. It also includes benefits like ambulance services with a 20% coinsurance, skilled nursing facility care with copays, and over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $1835 per admission or stay for Medicare-covered stays. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include Outpatient Hospital Services with a 20% coinsurance and no copay, Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a minimum and maximum coinsurance of 20%, Outpatient Substance Abuse Services with a minimum and maximum 20% coinsurance for both individual and group sessions, and Outpatient Blood Services with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are also covered with no copay, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services have a $45 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers primary care services with a 20% coinsurance. Chiropractic services are covered with a 20% coinsurance, but routine care is not covered. Occupational therapy, physician specialist, mental health specialty, and other health care professional services are covered with a 20% coinsurance. Physical therapy and speech-language pathology services are covered with a 20% coinsurance, and additional telehealth benefits are covered with a coinsurance of 20% and a copay between $0 and $45. Psychiatric services are covered with a 20% coinsurance, and opioid treatment program services are covered with a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services with a coinsurance of 20%. Other services such as Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, with a coinsurance of at most 20% for routine hearing exams and no copay. Prescription hearing aids are covered with no copay, but the plan covers a maximum of $1000.00 per year, and prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance and no copay for some services. Routine eye exams have no copay and are limited to one per year.
Dental Services See details
Dental Services are covered, with 20% coinsurance for Medicare Dental Services. 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 are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic Services have a maximum benefit of $4,000 per year.
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 have coinsurance between 0% and 20%.
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 is covered, including durable medical equipment with a 20% coinsurance and requiring authorization, prosthetics and medical supplies with a 20% coinsurance, and diabetic equipment. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of up to 20%, while Lab Services have no copay and a coinsurance of up to 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 any of the sub-services, including 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, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. The plan provides OTC items with no copay, and meal benefits with no copay; however, 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.
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