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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) plan features an annual prescription drug deductible of $420. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply, with no copay required for three-month supplies filled via preferred mail order. Additionally, Tier 6 select care drugs are highly affordable, requiring no copay for any supply duration or pharmacy type. Higher-tier medications under this plan incur either coinsurance or set copayments, such as a 25% coinsurance for Tier 3 preferred brands and Tier 5 specialty drugs. Tier 4 non-preferred drugs carry a $100 copay for a one-month supply at both preferred and standard pharmacies. Utilizing preferred pharmacies and preferred mail-order services helps maximize your savings on these prescription drug costs.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers comprehensive medical coverage with a mix of copays and coinsurance, including a $1,950 copay per inpatient admission and no copay with 20% coinsurance for outpatient services. Primary, specialist, and diagnostic care require no copay and a 20% coinsurance, while emergency room visits carry a $115 copay that is waived upon admission. Preventive care, home health services, and routine fitness benefits are fully covered with no copays or coinsurance. For supplemental benefits, the plan provides generous allowances with no copays or coinsurance, including up to $3,000 annually for dental care and a $200 annual limit for eyeglasses. Hearing aids are covered up to $750 per ear annually with no copay, while routine hearing exams require no copay and a 20% coinsurance. Additionally, members can access up to 24 routine one-way transportation trips, home-delivered meals, and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Dual Access (HMO-POS D-SNP) with a $1,950 copayment per admission and no coinsurance for acute and psychiatric stays, subject to prior authorization. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers outpatient services with no copayments, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year 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 no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 lifetime maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits offered by Wellcare Dual Access (HMO-POS D-SNP) feature no copay and 20% coinsurance for primary care, specialist, therapy, psychiatric, and mental health services, while telehealth has a $0 to $40 copay and 20% coinsurance. Chiropractic benefits are partially covered, offering up to 12 routine visits per year with no copay and no coinsurance, but other chiropractic services and podiatry services are not covered.
Preventive Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams, fitness benefits, and in-home support. Other services like kidney disease education and glaucoma screenings are covered with no copay and 20% coinsurance, but the benefit is only partially covered as health education, nutritional/dietary benefits, and personal emergency response systems are not covered.
Hearing Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers hearing services with no deductible, including one annual routine hearing exam with no copay and 20% coinsurance, and one annual fitting evaluation with no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear annually, 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) covers vision services with no deductibles, though other eye exam services are not covered. Routine eye exams (one per year) and contact lenses have no copay and a 20% coinsurance, while eyeglasses, lenses, frames, and upgrades have no copay and no coinsurance under a $200 annual maximum.
Dental Services See details
Dental services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), with maxillofacial prosthetics, implant services, and orthodontics not covered. Medicare-covered dental services require no copay and 20% coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance up to a $3,000 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay, while Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance. Other covered Medicare Part B chemotherapy, radiation, and miscellaneous drugs have a coinsurance ranging from 0% to 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 medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay and 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, subject to prior authorization. Covered benefits include outpatient diagnostic tests, lab services, X-rays, and therapeutic radiological services.
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.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Wellcare Dual Access (HMO-POS D-SNP) with no copay, but only some services are covered in practice. Specifically, 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) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and 71 to 100, and a $218 daily copay for days 21 to 70. Prior authorization is required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers partially covered other services, including acupuncture limited to 12 treatments yearly, over-the-counter (OTC) items, and a meal benefit with no copay and no coinsurance. Highly integrated services for dual-eligible SNPs are not covered under this plan.
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