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Wellpoint Full Dual Advantage Aligned (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Full Dual Advantage Aligned (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 Full Dual Advantage Aligned (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellpoint Full Dual Advantage Aligned (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 TX. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellpoint Full Dual Advantage Aligned (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 Full Dual Advantage Aligned (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 Full Dual Advantage Aligned (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 Full Dual Advantage Aligned (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 $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 $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 Full Dual Advantage Aligned (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs. This no-copay benefit applies to one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. For other drug tiers, you will pay a 25% coinsurance for Tier 3 preferred brand and Tier 4 non-preferred drug prescriptions. Tier 5 specialty tier medications also require a 25% coinsurance, which is applicable to a one-month supply. These cost-sharing details help you understand your out-of-pocket expenses for medications under this Wellpoint Medicare plan.
Additional Benefits
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. Outpatient care, primary care visits, specialist consultations, and diagnostic services generally feature no copay but require a 20% coinsurance. For immediate needs, emergency room visits carry a $115 copay, which is waived if admitted, while urgent care has a $40 copay. This plan also provides robust supplemental benefits, including preventive and comprehensive dental care with no copay or coinsurance up to a $3,500 annual limit. Members pay no copay for routine vision and hearing exams, which feature generous coverage limits for hearing aids and contact lenses. Additionally, you can access acupuncture, over-the-counter items, and up to 48 one-way trips for plan-approved transportation with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, although prior authorization is required. Standard Medicare-defined stays are covered, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) offers outpatient services with no copay and 20% coinsurance for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers primary care, specialist, therapy, psychiatric, and opioid treatment services with no copay and 20% coinsurance, while telehealth benefits have no copay and no coinsurance. Chiropractic services are not covered.
Preventive Services See details
Preventive services under the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) are partially covered, offering annual physical exams and kidney education with no copay and no coinsurance. While select supplemental benefits like memory fitness and home safety devices are covered with no copay and no coinsurance, other services like health education, nutritional benefits, and in-home support are not covered. Glaucoma screenings and diabetes self-management training require a referral and carry a 20% coinsurance with no copay.
Hearing Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers hearing services with no deductible, including annual routine exams for a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually—excluding inner ear, outer ear, and over-the-ear models—while OTC hearing aids are covered with no copay or coinsurance up to $300 per year.
Vision Services See details
Vision services are partially covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP), with other eye exam services and eyewear upgrades excluded from coverage. Covered services like annual routine eye exams and eyewear have no deductible and no copay, though a 20% coinsurance applies to routine exams and contact lenses up to a $450 annual limit.
Dental Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance for preventive and comprehensive care up to a $3,500 yearly limit, while Medicare-covered dental services have no copay and a 20% coinsurance. Implant services, maxillofacial prosthetics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs under this benefit have a coinsurance ranging from 0% to 20% with no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetic devices and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are covered with no copay and no coinsurance, though prior authorization and manufacturer limitations may apply to certain equipment.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers diagnostic and radiological services with no copay, subject to a 20% coinsurance. Prior authorization and referrals are required for all covered services, including diagnostic tests, lab work, therapeutic radiology, diagnostic radiology, and outpatient X-rays.
Home Health Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, though prior authorization is required. Some services are covered, but 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
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) partially covers other services with no copay and no coinsurance, including unlimited acupuncture, over-the-counter (OTC) items, chronic illness meal benefits, and Medicare Community Resource Support. Highly integrated services for dual eligibles are not covered under this plan, and the OTC benefit does not cover all drugs on the CMS OTC list.
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