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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 $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 Full Dual Advantage Aligned (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay 25% coinsurance for most drugs, regardless of the pharmacy. For specialty tier drugs, you will pay a $1 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing options. Many services, such as primary care, outpatient, and preventive services, have coinsurance costs, with some services like routine eye exams and hearing exams having no copay. Emergency services have a copay, but other services such as transportation and home health services have no copay. This plan includes coverage for inpatient and outpatient services, along with hearing, vision, and dental care. You will find no copays for many services, including hearing exams, routine eye exams, and home health services. The plan also provides coverage for medical equipment, and other services like acupuncture and OTC items, with varying cost-sharing, and some services that are not covered.
Inpatient Hospital See details
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan covers inpatient hospital services, including acute and psychiatric care, with coinsurance costs that align with Original Medicare. Additional days, non-Medicare stays, and upgrades for inpatient hospital stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, and ambulatory surgical center services and outpatient substance abuse services have a minimum of 20% and maximum of 20% coinsurance. Outpatient blood services have 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. Prior authorization is required for this benefit.
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 to a plan-approved health-related location have no copay and are limited to 65 one-way trips per year.
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, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan covers primary care physician, occupational therapy, physician specialist, mental health specialty, podiatry, other health care professional, psychiatric, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services. Primary care physician, chiropractic, physician specialist, mental health specialty, podiatry, other health care professional, psychiatric, and physical therapy services have a 20% coinsurance. Additional telehealth benefits have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services. Additional preventive services may have a copay, and some services such as health education, in-home safety assessments, medical nutrition therapy, and others are not covered. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits 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. Routine hearing exams have no copay and a maximum coinsurance of 20%, while fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) have no copay and a maximum benefit of $3,000 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids have no copay with 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 contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Contact lenses have a 20% coinsurance, and upgrades are not covered.
Dental Services See details
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment with no copay. Medicare dental services have a 20% coinsurance, and other dental services have a maximum benefit of $5,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with 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, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a coinsurance between 0% and 20%, and requires authorization. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic supplies and therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic and radiological services. For Diagnostic Procedures/Tests and Lab Services, you will pay at most 20% coinsurance. For Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you will pay at most 20% coinsurance.
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, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan. Prior authorization is required for this benefit if it were covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered and require prior authorization. The plan follows Original Medicare for the cost share for tier 1, and additional days beyond Medicare-covered SNF stays, as well as non-Medicare-covered stays, are not covered.
Other Services See details
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan covers acupuncture, over-the-counter (OTC) items, meal benefits, and other services. Acupuncture has no copay, while OTC items and meal benefits also have no copay. Some other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and more are not covered.
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