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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 2026, 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 3 out of 5 stars in 2026.
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 $9.10. 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 Wellpoint Full Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Members benefit from no copay on Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when filled at standard pharmacies or via standard mail order. This provides excellent cost savings for those requiring standard daily maintenance medications. For brand-name and specialty medications, the plan transitions to a coinsurance model. You will pay a 25% coinsurance for Tier 3 preferred brand and Tier 4 non-preferred drugs across one-, two-, or three-month supplies. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply through standard retail or mail-order pharmacies.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) offers comprehensive medical coverage with no copays for inpatient hospital stays, skilled nursing, and home health services. While primary and specialist visits require no copay, they are subject to a 20% coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted, while urgent care services require a $40 copay. For extra health benefits, this plan features a generous $3,500 annual dental allowance and up to $3,000 for prescription hearing aids with no copays or coinsurance for most services. Members also receive up to 60 free one-way transportation trips to approved locations and a $350 annual allowance for eyewear. Additionally, there are no copays for over-the-counter items, home infusion services, and diabetic equipment.
Inpatient Hospital See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers outpatient services with no copays, although outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services require a 20% coinsurance, prior authorization, and a referral. Outpatient blood services are covered with no copay, no coinsurance, and no deductible, though a referral is required.
Partial Hospitalization See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required before receiving these services.
Ambulance and Transportation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers ambulance and transportation services, with ground and air ambulance services requiring prior authorization and carrying a 20% coinsurance with no copay. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, but trips to any health-related location are not covered.
Emergency Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copays or coinsurance, up to a $100,000 maximum plan benefit limit.
Primary Care See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance, while telehealth features no copay and no coinsurance. Chiropractic services are partially covered, offering up to 24 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Wellpoint Full Dual Advantage (HMO D-SNP) are partially covered, featuring annual physical exams, kidney disease education, and select supplemental benefits like fitness and personal emergency response systems with no copays and no coinsurance. A 20% coinsurance and no copay (referral required) apply to services such as glaucoma screenings and diabetes self-management, while other options like health education, medical nutrition therapy, and in-home support are not covered.
Hearing Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) offers hearing services with no deductibles, including routine hearing exams for a 20% coinsurance and no copay, and fitting evaluations with no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to a $3,000 annual limit—excluding inner ear, outer ear, and over-the-ear types—while OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no deductibles, though other eye exam services and eyewear upgrades are not covered. One routine annual eye exam is covered with no copay and a 20% coinsurance, while eyeglasses and contact lenses are covered up to a $350 annual limit with no copays, featuring no coinsurance for eyeglasses and a 20% coinsurance for contact lenses.
Dental Services See details
Dental services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP), which offers up to $3,500 annually with no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services have no copay and a 20% coinsurance, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers medical equipment with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic supplies. There is no coinsurance for diabetic equipment, while coinsurance is 20% for prosthetics and medical supplies, and ranges from no coinsurance up to 20% for DME.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services with no copays and a 20% coinsurance. Prior authorization and referrals are required for these services, which include lab tests, diagnostic procedures, therapeutic radiology, and outpatient X-rays.
Home Health Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home health services with no copay and no coinsurance. Members will need to obtain both a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, though some services are not covered in practice. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and instead require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. This benefit does not require a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) provides other services including acupuncture, over-the-counter items, chronic illness meals, and Medicare community resource support with no copay and no coinsurance. Highly integrated services for dual eligible SNPs are not covered under this plan benefit.
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