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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 2025, 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 2025.
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 $14.80. 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 Full Dual Advantage Aligned (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you will enter the next coverage phase. If you qualify for the low-income subsidy, you may have your Part D premium reduced to $14.80 per month. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including vision exams, OTC hearing aids, and home health services. However, some services, like primary care, outpatient services, and diagnostic services, have a coinsurance of up to 20%. The plan also covers hearing aids with a maximum benefit of $3,000 per year and dental services with a $5,500 annual maximum. Emergency services have a $90 copay, while urgent care has a $45 copay. Additionally, the plan provides coverage for ambulance and transportation services, and offers an annual physical exam with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan, but additional days and non-Medicare-covered stays for both are not covered. The plan requires prior authorization for these services and has coinsurance costs; see below for more information.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services, individual and group sessions for outpatient substance abuse, and outpatient blood services are covered, with outpatient blood services having no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan, with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and Transportation Services have no copay, with coverage for up to 65 one-way trips per year to plan-approved health-related locations.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan. Emergency Services have a $90 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with 20% coinsurance, Chiropractic Services with 20% coinsurance (but not routine care), Occupational Therapy Services with 20% coinsurance, Physician Specialist Services with 20% coinsurance, and Mental Health Specialty Services with 20% coinsurance for individual and group sessions. The plan also covers Podiatry Services with 20% coinsurance for routine foot care and no copay for Medicare-covered podiatry services, Other Health Care Professional services with 20% coinsurance, Psychiatric Services with 20% coinsurance for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with 20% coinsurance, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services that may require a copay and/or coinsurance. This plan covers Personal Emergency Response System (PERS) and Fitness Benefit, both with no copay. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and a copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids have a maximum benefit of $3,000 per year with no copay, and OTC hearing aids have no copay and a maximum benefit of $300 per year.
Vision Services See details
Vision Services include eye exams and eyewear. Routine eye exams have no copay and a 20% coinsurance, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay and no coinsurance. Eyewear upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $5,500 annual maximum. Medicare Dental Services have a 20% coinsurance, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), 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 have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required, and coinsurance may apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization is required, and coinsurance applies.
Other Services See details
Other Services include acupuncture with no copay, over-the-counter items with no copay, a meal benefit with no copay, and Medicare Community Resource Support with no copay. Additionally, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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