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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 2026, 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 3 out of 5 stars in 2026.
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 $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 Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs for 1-month, 2-month, or 3-month supplies filled at standard pharmacies or through standard mail order. This makes essential medications highly affordable for members who rely on these specific drug tiers. For other drug categories, including Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, members are responsible for a 25% coinsurance across 1-month, 2-month, and 3-month supplies. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) plan offers comprehensive medical coverage with no copay for inpatient hospital stays, primary care, specialist visits, and home health services. While most outpatient, diagnostic, and ambulance services require no copay, they typically feature a 20% coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted, while urgently needed care has a $40 copay. Members also benefit from robust supplemental coverage, including dental services with no copay and no coinsurance up to a $2,400 annual limit. Routine vision and hearing exams are available with no copay and 20% coinsurance, alongside allowances of up to $200 for eyewear and $3,000 for prescription hearing aids. Additionally, the plan covers up to 34 one-way routine transportation trips per year and select over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay and no coinsurance, and prior authorization or referrals are required for most of these services.
Partial Hospitalization See details
Wellpoint Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Wellpoint Dual Advantage (HMO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered with no copay or coinsurance for up to 34 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with no copay and no coinsurance.
Primary Care See details
Wellpoint Dual Advantage (HMO D-SNP) covers primary care, specialist visits, and telehealth with no copays and no coinsurance. Physical, occupational, mental health, psychiatric, podiatry, and opioid treatment services are covered with no copays and 20% coinsurance. Chiropractic care is partially covered, offering routine care with no copay and 20% coinsurance for up to 24 visits per year, while other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Wellpoint Dual Advantage (HMO D-SNP), offering annual physical exams and kidney disease education with no copay and no coinsurance, while other screenings like glaucoma and diabetes self-management require a referral and have a 20% coinsurance and no copay. Additional preventive benefits are partially covered with no copay and no coinsurance, but health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers hearing services with no deductible, including one annual routine hearing exam with a 20% coinsurance and no copay, and one annual fitting evaluation with no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually for both ears, though inner ear, outer ear, and over the ear types are not covered. OTC hearing aids are also covered with no copay or coinsurance up to $300 annually.
Vision Services See details
Vision Services are partially covered by Wellpoint Dual Advantage (HMO D-SNP) with no deductible, including one annual routine eye exam with no copay and 20% coinsurance. Eyewear is covered up to a $200 yearly limit with no copay, featuring no coinsurance for eyeglasses and 20% coinsurance for contact lenses, though upgrades and other eye exam services are not covered.
Dental Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers Medicare dental services with no copay and a 20% coinsurance, and other dental services with no copay and no coinsurance up to a $2,400 annual maximum. This benefit is partially covered, as implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature a coinsurance of 0% to 20%.
Dialysis Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers dialysis services with no copay and 20% coinsurance.
Medical Equipment See details
Wellpoint Dual Advantage (HMO D-SNP) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, while prosthetics and medical supplies are covered with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Wellpoint Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance for Medicare-covered lab services, diagnostic procedures, X-rays, and radiological services. Prior authorization and referrals are required for all of these covered diagnostic and radiological benefits.
Home Health Services See details
Home Health Services are covered under the Wellpoint Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance. Both a referral and prior authorization are required to receive these services.
Cardiac Rehabilitation Services See details
Wellpoint Dual Advantage (HMO D-SNP) offers cardiac rehabilitation services with no copay, but only some services are covered as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellpoint Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. Admission is allowed without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers other services including acupuncture, over-the-counter (OTC) items, chronic illness meals, and Medicare Community Resource Support with no copay and no coinsurance. Prior authorization is required for acupuncture and a referral is needed for community resource support, while some other services in this category are not covered.
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* 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.
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