A non-government entity
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 2026, 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 3.5 out of 5 stars in 2026.
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 $25.60. 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 $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 $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:
Sign up for Wellcare Dual Reserve (HMO-POS D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Dual Reserve (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 6 Select Care Drugs, members pay no copay at preferred, standard, or mail-order pharmacies. Tier 1 Preferred Generic and Tier 2 Generic drugs have low copays starting at $18 and $19 for a one-month supply, and both tiers offer no copay for a three-month supply ordered through preferred mail delivery. For brand-name and specialized medications, Tier 3 Preferred Brand drugs and Tier 5 Specialty Tier drugs require a 25% coinsurance. Tier 4 Non-Preferred Drugs have a $100 copay for a one-month supply at both preferred and standard pharmacy locations. Comparing these copayments and coinsurance options helps you determine your total out-of-pocket prescription costs under this Wellcare Medicare plan.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers robust coverage with no copay for primary care visits, telehealth, and routine preventive services. For inpatient hospital stays, members pay a $275 daily copay for days 1 through 9 and no copay for days 10 through 90, with no coinsurance required. Emergency room visits carry a $150 copay, while urgent care services require a $25 copay, both of which are waived if you are admitted to the hospital. This plan also features excellent supplemental benefits, including no copay for routine dental, vision, and hearing exams, alongside allowances for glasses and hearing aids. Members also benefit from 24 one-way trips to approved health locations with no copay and no copay for home health services. Most medical equipment and dialysis services require a 20% coinsurance with no copay, making healthcare costs predictable and manageable.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers inpatient hospital services with no coinsurance, although prior authorization is required and upgrades, additional days, and non-Medicare-covered stays are not covered. Covered acute stays require a $275 copay for days 1 to 9 and no copay for days 10 to 90, while psychiatric stays require a $225 copay for days 1 to 9 and no copay for days 10 to 90.
Outpatient Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers outpatient services with no coinsurance, featuring copays of $0 to $225 for outpatient hospital services and $150 for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Dual Reserve (HMO-POS D-SNP), featuring a $275 copay and no coinsurance for Medicare-covered ground and air ambulance rides. Additionally, the plan offers up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to other non-approved health locations is not covered.
Emergency Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum benefit with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO-POS D-SNP) provides primary care physician services and telehealth benefits with no copay and no coinsurance. Other covered services, including specialists, mental health, and physical therapy, require copays ranging from $20 to $40 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers preventive services, including annual physical exams and screenings, with no copay and no coinsurance, though kidney disease education has a 20% coinsurance. Additional preventive benefits are partially covered with no copay or coinsurance for fitness and remote access, but sub-services like health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers hearing services with no deductible, featuring a $20 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers vision services with no deductibles or coinsurance, though prior authorization is required. Routine eye exams (one yearly) and eyewear like contacts and glasses have no copay up to a $200 annual limit, but other exams may require a copay up to $20.00, and non-routine "other" eye exam services are not covered.
Dental Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) offers partially covered dental services, featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive care. While most dental services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures feature no coinsurance and a copay of $0 to $20, while lab services have no copay; radiological services include outpatient X-rays with a $40 copay and coinsurance, therapeutic services with a minimum 20% coinsurance, and diagnostic radiology with copays starting at $0.
Home Health Services See details
Home Health Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Cardiac Rehabilitation Services with no coinsurance, though some services are not covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copays ranging from $30 to $65.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no coinsurance, prior authorization required, and no prior three-day hospital stay needed. There is no copay for days 1 to 20 and days 41 to 100, a $218 daily copay for days 21 to 40, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), featuring over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, dual eligible SNPs with highly integrated services, and other additional services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved