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Wellcare Dual Reserve (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (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 Reserve (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Reserve (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 LA. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Dual Reserve (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 Reserve (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 Reserve (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 Reserve (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.60. 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 $3600.00 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 Reserve (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. This plan's premium may be reduced if you qualify for the low-income subsidy, and the monthly premium is $55.60.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers a range of benefits with varying costs. Hospital stays have a copay depending on the type of care and length of stay, while outpatient services have copays that range from $0 to $225. Emergency and urgent care services have copays, and ambulance services have a $275 copay. This plan provides coverage for primary care, mental health, and various therapies with copays. Preventive services, including annual exams, are available with no copay. Hearing and vision services include exams and hearing aids with copays and maximum benefits, and dental services offer a wide range of services, many with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage, including Acute and Psychiatric, requires prior authorization. For Inpatient Hospital-Acute, you'll pay a $300 copay for days 1-9, and no copay for days 10-90; additional days, non-Medicare-covered stays, and upgrades are not covered. For Inpatient Hospital Psychiatric, you'll pay a $225 copay for days 1-9, and no copay for days 10-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $225, Observation Services with a copay between $140 and $225, Ambulatory Surgical Center (ASC) Services with a $150 copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay of $40, and Outpatient Blood Services with no copay. This plan also offers an enhanced benefit for Outpatient Blood Services, waiving the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers ambulance services with a $275 copay for both ground and air ambulance services, and transportation services with no copay for plan-approved health-related locations, up to 24 one-way trips per year via rideshare services, bus/subway, or medical transport; transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency and Urgent Coverage, are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Emergency Services have a $140 copay, and Urgent Care has a $25 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage also have a $140 copay, with no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physician specialist services with a $25 copay. Mental health specialty services, psychiatric services, and other health care professional services have a copay of $40 for individual sessions and $40 for group sessions. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Opioid treatment program services have a $25 copay.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and other services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visits, all with no copay. Kidney disease education services have a 20% coinsurance. Some services such as health education, in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay and prescription hearing aids with a $500 maximum plan benefit per year, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers vision services including eye exams and eyewear. Eye exams have a copay of $0-$25, while routine eye exams have no copay. Eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, with a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $25 copay, oral exams with no copay, dental x-rays with no copay, and other diagnostic services with no copay. This plan offers orthodontic services with a maximum benefit of $2,000 per year, and covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance for Medicare-covered items, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $175, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. This includes 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, but require prior authorization. For days 1-20, there is no copay, for days 21-40, the copay is $214, and for days 41-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan's "Other Services" benefit includes Over-the-Counter (OTC) Items and Meal Benefits. 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. Over-the-counter items have no copay, and meal benefits also have no copay with a doctor's referral.
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