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Wellpoint Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint 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 Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Wellpoint 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 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 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 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 Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 Wellpoint Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. Once the deductible is met, you will pay coinsurance for your prescriptions. In the initial coverage phase, you will pay 15% to 25% coinsurance for generic and brand-name drugs, depending on the pharmacy and drug tier. For specialty drugs, you will have a $1 copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including primary care, hearing exams, and home health services. You may have a copay for emergency services and partial hospitalization, and coinsurance applies to services like outpatient, vision, and dental. This plan covers inpatient and outpatient services, with coinsurance for some. It also includes coverage for ambulance services, preventive services, and durable medical equipment. Additional benefits include hearing, vision, and dental services, with specific cost-sharing for each.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered, but additional days and non-Medicare-covered stays for acute and psychiatric services are not covered. The plan's cost sharing is based on the original Medicare cost share.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a coinsurance between 20% and 20%, and ambulatory surgical center (ASC) services have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Dual Advantage (HMO D-SNP) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellpoint 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 are covered with no copay for up to 24 one-way trips per year, and Transportation Services to Any Health-related Location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Dual Advantage (HMO D-SNP) plan. Emergency Services have a $90 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Services have a maximum benefit coverage of $100,000, with no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, and Additional Telehealth Benefits have no copay. Chiropractic Services have a 20% coinsurance, and Routine Chiropractic Care has no copay. Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, Podiatry Services (Routine Foot Care), Psychiatric Services (Individual and Group Sessions), Physical Therapy, Speech-Language Pathology Services, and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services may have a copay, and other preventive services have 20% coinsurance.
Hearing Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers hearing services, including routine hearing exams and fitting/evaluation for hearing aids with no copay, and a coinsurance of at most 20% for routine hearing exams. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay, and a maximum benefit of $300 per year.
Vision Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers vision services, including eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Upgrades are not covered.
Dental Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan offers dental services with a 20% coinsurance for Medicare Dental Services, and other dental services have a maximum benefit of $2500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and maxillofacial prosthetics have no copay. Restorative services, periodontics, prosthodontics (removable and fixed), and orthodontics require prior authorization and have a limited number of visits, while orthodontics is 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 under the Wellpoint Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a coinsurance of 0% to 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services each have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellpoint 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 covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit, and there is a coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the coinsurance details are available in the plan's details.
Other Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers acupuncture, over-the-counter (OTC) items, and a meal benefit with no copay. However, the plan does not cover 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, and several other services.
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