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Wellpoint Dual Advantage 2 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Dual Advantage 2 (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 2 (HMO D-SNP) in 2025, please refer to our full plan details page.
Wellpoint Dual Advantage 2 (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 Texas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellpoint Dual Advantage 2 (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 2 (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 2 (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 2 (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 $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 $9350.00 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 2 (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. During the initial coverage phase, after you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you may pay $8.00 copay for preferred generic drugs at a standard or mail order pharmacy. For specialty tier drugs, you will pay a $1.00 copay at a standard or mail order pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellpoint Dual Advantage 2 (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, like primary care visits, routine eye exams, and dental services such as oral exams and x-rays, have no copay. Other services, such as outpatient hospital services, hearing exams, and vision services, have a coinsurance of up to 20%. The plan also covers important services like ambulance, emergency, and home health services, often with no copay. The plan provides additional benefits, including coverage for hearing aids and eyewear, with specific limits on coverage amounts.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and have coinsurance costs that follow Original Medicare. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, both with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, with a minimum coinsurance of 20% and a maximum coinsurance of 20%. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Dual Advantage 2 (HMO D-SNP) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Dual Advantage 2 (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay. Transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the Wellpoint Dual Advantage 2 (HMO D-SNP) plan with a $90 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Services are covered with a maximum plan benefit of $100,000, and Worldwide Emergency, Urgent Coverage, and Emergency Transportation have no copay.
Primary Care See details
The Wellpoint Dual Advantage 2 (HMO D-SNP) plan covers primary care physician services with no copay, chiropractic services with 20% coinsurance, occupational therapy services with 20% coinsurance, physician specialist services with no copay, mental health specialty services with 20% coinsurance, podiatry services with 20% coinsurance and no copay, other health care professional services with no copay, psychiatric services with 20% coinsurance, physical therapy and speech-language pathology services with 20% coinsurance, additional telehealth benefits with no copay, and opioid treatment program services with 20% coinsurance. However, routine chiropractic care is not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Annual physical exams have no copay. Other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, have a 20% coinsurance.
Hearing Services See details
The Wellpoint Dual Advantage 2 (HMO D-SNP) plan covers hearing exams with a coinsurance of at most 20% for routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay and a maximum benefit of $1,500 per year, and OTC hearing aids are covered with no copay and a maximum benefit of $300 per year.
Vision Services See details
The Wellpoint Dual Advantage 2 (HMO D-SNP) plan covers vision services, including routine eye exams with no copay and 20% coinsurance, and eyewear. Eyewear includes contact lenses with no copay and 20% coinsurance, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames with no copay, and upgrades are not covered. There is a combined maximum plan benefit coverage amount of $150 for eyewear.
Dental Services See details
The Wellpoint Dual Advantage 2 (HMO D-SNP) plan covers Medicare Dental Services with a 20% coinsurance, and other dental services with a $2,000 annual maximum benefit. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. This plan includes coverage for Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Dual Advantage 2 (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, and Prosthetic Devices and Medical Supplies with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellpoint Dual Advantage 2 (HMO D-SNP) plan. For diagnostic procedures, tests, and lab services, there is no copay, and the coinsurance is at most 20%. For diagnostic, therapeutic radiological, and outpatient X-ray services, there is no copay, and the coinsurance is at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellpoint Dual Advantage 2 (HMO D-SNP) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellpoint Dual Advantage 2 (HMO D-SNP) plan. Services including 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not cover additional days beyond Medicare-covered SNF days, and it does not cover non-Medicare-covered SNF stays.
Other Services See details
The Wellpoint Dual Advantage 2 (HMO D-SNP) plan covers acupuncture with no copay, up to 24 treatments per year, and also covers over-the-counter items and meal benefits with no copay. The plan also covers Medicare Community Resource Support with no copay, and some additional services are not covered.
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