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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 $520.00 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 $520. However, members benefit from no copay on Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using standard pharmacies or standard mail order. This budget-friendly benefit applies to one, two, and three-month supplies of these essential medications. For brand-name and specialized drugs, cost sharing is structured as a percentage of the drug cost. Tier 3 preferred brands and Tier 4 non-preferred drugs require a 25% coinsurance for one, two, or three-month supplies. High-cost Tier 5 specialty drugs require a 27% coinsurance for a one-month supply through standard retail or mail-order channels.
Additional Benefits
The Wellpoint Full Dual Advantage Aligned (HMO D-SNP) offers comprehensive medical coverage with no copays for inpatient hospital stays, primary care, and home health services, though coinsurance applies to many specialist and outpatient services. Emergency room visits require a $115 copay, which is waived if you are admitted within 24 hours, while urgent care has a $40 copay and no coinsurance. Additionally, the plan covers skilled nursing facility stays and up to 65 one-way transportation trips per year to approved health locations with no copay and no coinsurance. For everyday wellness, the plan provides robust dental benefits up to $4,500 annually and eyewear coverage up to $450 annually with no copay, no coinsurance, and no deductible. Hearing aids are also covered up to $3,000 per year with no copay or coinsurance, alongside acupuncture, meals for chronic illness, and over-the-counter items. Most diagnostic services, dialysis, and durable medical equipment feature no copays but are subject to a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copay, though Medicare-defined coinsurance applies and prior authorization is required. Additional days, room upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered under the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copays, although a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required for 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. 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, 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, which is waived if admitted to the hospital within 24 hours, and urgent care with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay or 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 visits, mental health, podiatry, and therapy services with no copay and a 20% coinsurance. Telehealth benefits are also available with no copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive services under the Wellpoint Full Dual Advantage Aligned (HMO D-SNP) are partially covered, with annual physicals, kidney disease education, and select supplemental benefits like fitness and PERS carrying no copay and no coinsurance. Other services, such as glaucoma screenings and diabetes self-management training, require a referral and have a 20% coinsurance with no copay, while sub-services like health education, nutritional therapy, and in-home safety assessments are not covered.
Hearing Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) offers partially covered hearing services with no deductible, excluding inner ear, outer ear, and over-the-ear prescription hearing aids. Routine exams require a 20% coinsurance and no copay, while fitting evaluations, prescription hearing aids up to $3,000 annually, and OTC hearing aids up to $300 annually are covered with no copays 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 upgrades not covered. Covered routine eye exams (one per year) and contact lenses require no copay and a 20% coinsurance, while eyeglasses, lenses, and frames have no copay, no coinsurance, and no deductible up to a $450 annual limit.
Dental Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) partially covers dental services, providing up to $4,500 annually with no copay and no coinsurance for preventive and most comprehensive care, while Medicare-covered dental services have no copay and a 20% coinsurance. 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 chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin drugs require 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
Medical equipment is covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copays, though prior authorization and coinsurance may apply. Durable medical equipment features a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment is fully covered with no copay and no coinsurance.
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, though prior authorization and referrals are required. This coverage applies to outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, 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 some Cardiac Rehabilitation Services with no copay, but intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellpoint Full Dual Advantage Aligned (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, although the plan does allow admission without a prior three-day inpatient hospital stay.
Other Services See details
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) partially covers other services, offering acupuncture, over-the-counter (OTC) items, meals for chronic illness, and Medicare Community Resource Support with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
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