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Wellpoint Full Dual Advantage 2 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Full Dual Advantage 2 (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 2 (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellpoint Full Dual Advantage 2 (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 2 (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 2 (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 2 (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 2 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $615.00 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 2 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries will enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when filled at standard pharmacies or through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies of these medications. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, the plan charges a 25% coinsurance for one-month, two-month, and three-month fills. Tier 5 specialty drugs also require a 25% coinsurance, which is restricted to a one-month supply. This structure makes it easy to understand your out-of-pocket costs for prescription medication under this HMO D-SNP plan.
Additional Benefits
The Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan offers comprehensive healthcare coverage with no copays or coinsurance for inpatient hospital stays, home health care, and skilled nursing facility services. For outpatient hospital services, specialist visits, and diagnostic tests, members will pay no copay but are subject to a 20% coinsurance. Emergency room visits require a $115 copay, which is waived if you are admitted within 24 hours, while urgently needed care carries a $40 copay. For supplemental care, the plan features robust dental coverage with no copay or coinsurance up to a $3,500 annual limit for non-Medicare services. Routine hearing and vision benefits also feature no copays, providing up to $3,000 annually for prescription hearing aids and a $325 annual allowance for covered eyewear. Additionally, members can access up to 48 one-way transportation trips per year to plan-approved locations and receive acupuncture and over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellpoint Full Dual Advantage 2 (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers outpatient services with no copays, though 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 services are covered by Wellpoint Full Dual Advantage 2 (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 2 (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay, requiring prior authorization for both ground and air transport. Transportation services are partially covered with no copay or 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 2 (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 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with no copays or coinsurance.
Primary Care See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers primary care, specialist, therapy, mental health, podiatry, and opioid treatment services with no copay and a 20% coinsurance, while additional telehealth benefits have no copay and no coinsurance. Chiropractic services are not covered in practice under this plan.
Preventive Services See details
Preventive services are covered by Wellpoint Full Dual Advantage 2 (HMO D-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, fitness benefits, personal emergency response systems, remote access technologies, and home safety devices. Some services, including glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs, require a referral and carry a 20% coinsurance with no copay. Additional preventive benefits are partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling.
Hearing Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers hearing services with no deductible, featuring routine hearing exams with a 20% coinsurance and no copay, and hearing aid fittings with no copay or coinsurance. Prescription hearing aids (excluding inner ear, outer ear, and over the ear types) are covered up to $3,000 annually, and OTC hearing aids are covered up to $300 annually, both with no copays or coinsurance.
Vision Services See details
Vision Services are partially covered by Wellpoint Full Dual Advantage 2 (HMO D-SNP), offering one routine eye exam per year with no copay and a 20% coinsurance, while other eye exam services are not covered. Covered eyewear—including contact lenses, eyeglasses, lenses, and frames—has no copay and a combined annual limit of $325, though contact lenses are subject to a 20% coinsurance and upgrades are not covered.
Dental Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers Medicare dental services with no copay and a 20% coinsurance, and other dental services with no copay, no coinsurance, and a $3,500 annual limit. The plan's dental benefit is partially covered, as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellpoint Full Dual Advantage 2 (HMO D-SNP) with no copays for durable medical equipment (DME), prosthetics, and diabetic supplies. DME carries a 0% to 20% coinsurance, Medicare-covered prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment has no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellpoint Full Dual Advantage 2 (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and referrals are required for these services, which include outpatient diagnostic tests, lab services, therapeutic radiology, and X-rays.
Home Health Services See details
Home health services are covered by Wellpoint Full Dual Advantage 2 (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization required, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) provides partial coverage for other services with no copay and no coinsurance for covered benefits, which include acupuncture, over-the-counter items, chronic illness meals, and Medicare community resource support. Highly integrated services for dual eligible SNPs are not covered under this plan.
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