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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 $550.00 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 $550. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when filled at standard retail pharmacies or standard mail order services. This coverage applies to one-month, two-month, and three-month supplies, helping to keep your everyday medication costs low. For other drug categories, standard retail pharmacies and standard mail order services require a 25% coinsurance for Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs. Tier 5 specialty medications carry a 26% coinsurance for a one-month supply. Knowing these specific coinsurance and deductible rates will help you accurately budget for your prescription drug needs.
Additional Benefits
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) offers comprehensive medical coverage with no copay for inpatient hospital stays, primary care, specialist visits, and home health services, though many outpatient services and professional visits carry a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted, while urgent care has a $40 copay. Additionally, diagnostic tests, medical equipment, and dialysis services generally feature no copay and a 20% coinsurance. This plan also provides robust supplemental benefits to reduce out-of-pocket costs, including preventive and comprehensive dental care up to $3,000 annually with no copay and no coinsurance. Beneficiaries also benefit from no copays on prescription hearing aids up to $3,000, eyewear up to $450, and up to 65 one-way transportation trips per year to approved health locations. Other valuable perks include no copays or coinsurance for acupuncture, over-the-counter items, and home safety devices.
Inpatient Hospital See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and Medicare-defined coinsurance, though prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and individual or group substance abuse sessions. Outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
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 the Wellpoint Full Dual Advantage Aligned (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services. Transportation services are partially covered, offering up to 65 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, but trips to any other health-related location are not covered.
Emergency Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to $100,000 with no copay and no coinsurance.
Primary Care See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers primary care, specialist, mental health, occupational/physical therapy, and podiatry services with no copay and a 20% coinsurance, while chiropractic services are not covered. Additional telehealth benefits are also available with no copay and no coinsurance.
Preventive Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers preventive services, including annual physicals and kidney disease education, with no copays and no coinsurance. Additional preventive benefits are partially covered, offering fitness, remote access, and home safety devices at no cost, though services like health education, nutritional therapy, and in-home support are not covered. A 20% coinsurance and referral are required for specific services, including glaucoma screenings and diabetes self-management training.
Hearing Services See details
Hearing services are partially covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP), offering routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids up to $3,000 annually and OTC hearing aids up to $300 annually are covered with no copays or coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no deductibles, featuring one routine eye exam annually with no copay and 20% coinsurance, while other eye exam services are not covered. Eyewear is covered up to a $450 annual limit with no copay and no coinsurance for eyeglasses, lenses, and frames, and no copay with 20% coinsurance for contact lenses, though upgrades are not covered.
Dental Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance, and preventive and comprehensive dental services with no copay and no coinsurance up to a $3,000 yearly maximum. Under this plan, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% 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 with no copay and up to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance, both requiring prior authorization. Diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance from specified manufacturers.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. Prior authorization and referrals are required for these covered services, which include diagnostic tests, lab work, therapeutic radiology, and outpatient X-rays.
Home Health Services See details
Home health services are covered under the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copay and no coinsurance. Both prior authorization and a referral are required to access these benefits.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, although only some services are covered in practice. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. While the plan permits admission without a prior three-day inpatient hospital stay, additional days beyond standard Medicare-covered limits are not covered.
Other Services See details
Other Services are partially covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP), featuring acupuncture, over-the-counter (OTC) items, chronic illness meal benefits, and Medicare Community Resource Support with no copay and no coinsurance. 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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