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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 $205.00 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:
Sign up for Wellpoint Full Dual Advantage Aligned (HMO D-SNP)
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Drug Coverage
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) prescription drug plan features an annual drug deductible of $205. Members pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when using standard pharmacies or standard mail order services. These cost-saving benefits apply to one-month, two-month, and three-month supply options. For higher-tier medications, costs are based on coinsurance through standard pharmacies and standard mail order. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs require a 25% coinsurance for all supply durations. Tier 5 specialty drugs carry a 30% coinsurance and are limited to a one-month supply.
Additional Benefits
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan offers comprehensive coverage with no copays on essential services like inpatient hospital stays, skilled nursing facility care, and home health services. While primary care visits, specialist consultations, outpatient services, and diagnostic tests require no copay, they typically carry a twenty percent coinsurance. Emergency department visits are subject to a one hundred fifteen dollar copay, which is waived upon immediate admission, while urgent care visits require a forty dollar copay. This plan also features valuable supplemental benefits, including up to four thousand dollars for preventive and comprehensive dental care with no copay or coinsurance. Additionally, members benefit from no copays on routine vision exams, a three hundred seventy-five dollar annual eyewear allowance, and up to three thousand dollars for prescription hearing aids. Other zero-copay perks include up to forty-eight one-way transportation trips per year to approved locations, acupuncture, and over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP), offering acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. Specific services that are not covered under this plan include additional days, non-Medicare-covered stays, and room upgrades.
Outpatient Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance, with the deductible waived for the first three pints.
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
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation is partially covered with no copay and no coinsurance for up to 48 one-way trips per year to plan-approved locations, though trips to any 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 require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $100,000 maximum plan limit.
Primary Care See details
Primary care and specialist services under the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) plan are covered with no copay and a 20% coinsurance, which also applies to mental health, therapy, and podiatry services. Additional telehealth benefits are available with no copay and no coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers annual physical exams and kidney disease education with no copay and no coinsurance, though some services require a referral. Additional preventive benefits are partially covered, offering a fitness benefit, remote access technologies, home safety devices, and a personal emergency response system with no copay and no coinsurance, while services like health education, nutritional therapy, and weight management programs are not covered. Other services, such as glaucoma screenings and diabetes self-management training, require a referral and carry a 20% coinsurance with no copay.
Hearing Services See details
Hearing services covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) feature no deductible, with routine exams requiring a 20% coinsurance and no copay, and fitting evaluations having no copay or coinsurance. Prescription hearing aids are partially covered up to $3,000 annually with no copay or coinsurance, excluding inner ear, outer ear, and over the ear models, while OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
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 not covered. Covered benefits have no deductible and include one annual routine eye exam with no copay and 20% coinsurance, plus a $375 yearly eyewear limit with no copay, which carries no coinsurance for eyeglasses and 20% coinsurance for contact lenses.
Dental Services See details
Dental services are partially covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP), with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $4,000 annual limit.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) 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 0% to 20% coinsurance, and prosthetics or medical supplies with no copay and 20% coinsurance, both requiring prior authorization. Diabetic equipment, including supplies and therapeutic shoes, is covered with no copay and no coinsurance, though manufacturer limitations apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copay and a minimum 20% coinsurance for all diagnostic tests, lab work, X-rays, and therapeutic radiology. Prior authorization and referrals are required for these covered services.
Home Health Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers home health services with no copay and no coinsurance, though a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, though some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond those covered by Medicare are not covered.
Other Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) provides partially covered other services with no copay and no coinsurance, including unlimited acupuncture, over-the-counter items, chronic illness meal benefits, and Medicare Community Resource Support. Highly integrated services for dual eligible SNPs and additional unspecified services 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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