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Wellcare Dual Access (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (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 Access (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Centene Corporation available for enrollment in 2026 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 Access (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 Access (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 Access (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 Access (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.00. 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 $420.00 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 Wellcare Dual Access (HMO-POS D-SNP) prescription drug plan has an annual drug deductible of $420. Tier 6 select care drugs feature no copay across all standard and preferred pharmacies, as well as mail order options. Additionally, Tier 1 preferred generic and Tier 2 generic drugs offer no copay for a three-month supply through preferred mail order, with one-month copays starting as low as $18. For brand-name and specialty medications, Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance. Tier 4 non-preferred drugs carry a $100 copay for a one-month supply at both preferred and standard pharmacies. These detailed cost-sharing structures help you estimate your out-of-pocket costs when choosing this Medicare plan.
Additional Benefits
Wellcare Dual Access (HMO-POS D-SNP) offers comprehensive healthcare coverage with predictable out-of-pocket costs, featuring no copays and a 20% coinsurance for doctor visits, outpatient services, and diagnostic tests. Inpatient hospital stays require a $1,810 copay per admission, while emergency room visits carry a $115 copay that is waived if you are admitted. Skilled nursing facility care is also available, featuring no copay for days 1 to 20 and days 71 to 100. This plan also includes valuable supplemental benefits, such as dental, vision, and hearing services with no copays and low to no coinsurance. Additionally, members receive home health services, acupuncture, over-the-counter items, and up to 24 one-way transportation trips per year with no copays or coinsurance. These additional wellness benefits make it easier to manage your daily health needs while keeping your medical expenses minimal.
Inpatient Hospital See details
Wellcare Dual Access (HMO-POS D-SNP) covers inpatient acute and psychiatric hospital stays with a copayment of $1,810 per admission or stay and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for several of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Wellcare Dual Access (HMO-POS D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Dual Access (HMO-POS D-SNP), with prior authorization required for both benefits. Medicare-covered ground and air ambulance services require a 20% coinsurance and no copay, while transportation services are partially covered with no copay or coinsurance for up to 24 yearly one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under Wellcare Dual Access (HMO-POS D-SNP) are generally covered with no copay and a 20% coinsurance, including primary care, specialist, therapy, and mental health services. Routine chiropractic care is covered for up to 12 visits per year with no copay and no coinsurance, though other chiropractic services and podiatry services are not covered.
Preventive Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers preventive services, featuring annual physical exams with no copay and no coinsurance, and kidney disease education and other screenings with no copay and 20% coinsurance. Additional preventive services are partially covered with no copay and no coinsurance for fitness, alternative therapies, in-home support, and remote access, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling are not covered.
Hearing Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers hearing services, including annual routine exams with no copay and a 20% coinsurance, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear each year, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers partially covered vision services with no deductibles, though other eye exam services are not covered. Covered routine exams and eyewear have no copays, but a 20% coinsurance applies to routine exams and contact lenses, while other eyewear has no coinsurance up to a $400 annual limit.
Dental Services See details
Wellcare Dual Access (HMO-POS D-SNP) partially covers dental services, featuring Medicare-covered dental with no copay and 20% coinsurance, alongside preventive and comprehensive services with no copay and no coinsurance. However, maxillofacial prosthetics, implant services, and orthodontics are not covered by the plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Wellcare Dual Access (HMO-POS D-SNP) with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access (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 services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance, with prior authorization required. This coverage includes outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay, though standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and 71 to 100, a $218 copay per day for days 21 to 70, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers acupuncture, over-the-counter items, and home meal benefits with no copay and no coinsurance, though some services require referrals or prior authorization. Other additional services and highly integrated services for dual eligibles are not covered under this plan.
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