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Wellpoint Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Full Dual Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Full Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Wellpoint Full Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Washington. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Wellpoint Full Dual Advantage (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellpoint Full Dual Advantage (HMO 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 Wellpoint Full Dual Advantage (HMO 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 Wellpoint Full Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $2.70. 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 Wellpoint Full Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs until your total drug costs reach $2000, at which point you enter the next coverage phase. Those who qualify for low-income subsidy (LIS) will pay $2.70 for Part D drugs.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers a variety of benefits with varying cost-sharing. Many services, such as ambulance transportation, outpatient blood services, preventive services, and home health services, have no copay. You may be responsible for coinsurance on services like inpatient and outpatient services, primary care, hearing, vision, dental, and home infusion services. This plan covers a range of services, including inpatient and outpatient care, and offers specific benefits like hearing aids and dental services. Emergency services have a copay, while other services such as over-the-counter items, acupuncture, and meals have no copay. Some services require prior authorization, and it's important to review the plan details for specific coinsurance amounts and limitations.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days, non-Medicare stays, and upgrades for both are not covered. For covered services, there is coinsurance, and prior authorization is required.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, as well as Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a minimum 20% and maximum 20% coinsurance. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 60 one-way trips per year.
Emergency Services See details
Emergency Services are covered, including emergency services, urgently needed services, and worldwide emergency services. Emergency services have a $90 copay, and urgently needed services have a $45 copay; Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Chiropractic Services has a 20% coinsurance, and routine chiropractic care has no copay. Occupational Therapy Services, Individual and Group Sessions for Mental Health and Psychiatric Services, Other Health Care Professional, and Opioid Treatment Program Services have a 20% coinsurance. Additional Telehealth Benefits has no copay. Podiatry Services has a 20% coinsurance, and Medicare-covered podiatry services have no copay.
Preventive Services See details
Preventive services include Medicare-covered preventive services, annual physical exams, and other preventive services. Annual physical exams have no copay, while the other services have varying copays and coinsurance.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a 20% coinsurance for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids; prescription hearing aids are covered with no copay, but are limited to a $3,000 benefit per year; and OTC hearing aids are covered with no copay, up to a $300 benefit per year. Prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers vision services, including eye exams with 20% coinsurance, and eyewear with 20% coinsurance. Routine eye exams have no copay, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Upgrades are not covered.
Dental Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and maxillofacial prosthetics with no copay; however, Medicare dental services have a 20% coinsurance. Restorative services, periodontics, prosthodontics, and prosthodontics fixed are limited, while orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services include coverage for 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, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies - Non-Medicare benefit with no copay and coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, as well as coinsurance for some services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan. There is no copay for any of these services, but you may have to pay coinsurance of up to 20% for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the Wellpoint Full Dual Advantage (HMO 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 Wellpoint Full Dual Advantage (HMO 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) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the coinsurance information is available in the plan details.
Other Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers acupuncture with no copay, over-the-counter (OTC) items with no copay, and a meal benefit with no copay. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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