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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 2026, 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 2026.
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 $230.00 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 Wellpoint Dual Advantage 2 (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $230. Under this plan, members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This no-copay benefit applies to one-month, two-month, and three-month supplies of these essential medications. For other drug tiers, costs are structured as coinsurance rather than flat copayments. Tier 2 generic drugs, Tier 3 preferred brand drugs, and Tier 4 non-preferred drugs all require a 25% coinsurance for one-month, two-month, and three-month supplies through standard network pharmacies and mail order. Specialty medications in Tier 5 carry a 30% coinsurance for a one-month supply.
Additional Benefits
Wellpoint Dual Advantage 2 (HMO D-SNP) offers robust coverage for essential medical services, featuring no copays and no coinsurance for inpatient hospital stays, skilled nursing facility care, home health services, and doctor visits. Many outpatient services, diagnostic tests, dialysis, and durable medical equipment are covered with no copay and a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted within 24 hours, while urgent care carries a $40 copay. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay or coinsurance up to a $2,000 annual limit. Additionally, members benefit from routine vision and hearing exams, allowances for eyewear and hearing aids, and up to 32 one-way transportation trips per year to plan-approved locations with no copay or coinsurance. Other covered perks include acupuncture treatments, chronic illness meals, and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Wellpoint Dual Advantage 2 (HMO D-SNP) partially covers inpatient hospital services for acute and psychiatric stays with no copay and no coinsurance, though prior authorization is required. Sub-services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 32 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are provided with no copay and no coinsurance up to a $100,000 maximum benefit.
Primary Care See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers primary care, specialist, and telehealth visits with no copay and no coinsurance. Physical, occupational, speech therapy, mental health, podiatry, and opioid treatment services are covered with no copay and 20% coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellpoint Dual Advantage 2 (HMO D-SNP), featuring no copay and no coinsurance for annual physicals, kidney disease education, fitness benefits, and home safety devices. Glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs require a referral and 20% coinsurance with no copay. However, health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Wellpoint Dual Advantage 2 (HMO D-SNP) with no deductible, offering routine exams and fitting evaluations for no copay, although routine exams require a 20% coinsurance. Prescription and OTC hearing aids are partially covered with no copay or coinsurance up to yearly limits of $1,500 and $300 respectively, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Wellpoint Dual Advantage 2 (HMO D-SNP), offering one annual routine eye exam with no copay and 20% coinsurance, though other eye exam services are not covered. Covered eyewear features a $175 annual limit with no deductible, providing contact lenses with no copay and 20% coinsurance, and eyeglasses, lenses, and frames with no copay and no coinsurance, while upgrades are not covered.
Dental Services See details
Dental services are partially covered by Wellpoint Dual Advantage 2 (HMO D-SNP), with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services feature no copay and a 20% coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellpoint Dual Advantage 2 (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization and vendor limitations may apply.
Diagnostic and Radiological Services See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. These services require both prior authorization and a referral.
Home Health Services See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Wellpoint Dual Advantage 2 (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, though only some services are covered and prior authorization is required. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for peripheral artery disease are not covered under this benefit and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellpoint Dual Advantage 2 (HMO D-SNP) with no copay and no coinsurance, and a prior three-day inpatient hospital stay is not required. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellpoint Dual Advantage 2 (HMO D-SNP) offers partially covered other services with no copay and no coinsurance, which include acupuncture up to 24 treatments yearly, over-the-counter items, chronic illness meals, and community resource support. Highly integrated services for dual-eligible SNPs are not covered under this plan.
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* 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.
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