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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 2025, 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 2025.
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 $18.30. 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 2 (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), the monthly premium for Part D is $18.30. During the initial coverage phase, you'll pay the costs for your drugs in each tier until your total drug costs reach $2000. Once you reach $2000 in out-of-pocket drug costs, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including outpatient blood services, additional telehealth benefits, worldwide emergency coverage, OTC hearing aids (up to $300 per year), routine eye exams, contact lenses, eyeglasses, diabetic supplies, and acupuncture. Other services, such as emergency services and inpatient hospital services, have copays or coinsurance, which can be up to 20% for many services, including outpatient services, primary care, and vision services. The plan also covers hearing aids, dental, and transportation, with specific limits and cost-sharing. Hearing aids have a maximum benefit of $3,000 per year for prescription hearing aids and no copay for OTC hearing aids. Dental services are covered up to a $4,500 annual maximum, and transportation services cover up to 96 one-way trips per year to plan-approved health-related locations with no copay.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with prior authorization required, with coinsurance costs based on Original Medicare. Additional days, non-Medicare stays, and upgrades for both acute and psychiatric inpatient hospital services are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, as well as Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a 20% coinsurance. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan, but requires prior authorization. The copay for this service is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, which have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, and include up to 96 one-way trips per year via rideshare, bus/subway, van, or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Full Dual Advantage 2 (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 each have no copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services have a 20% coinsurance. Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, and Other Health Care Professional have a 20% coinsurance. Podiatry Services have a 20% coinsurance, and Medicare-covered podiatry services have no copay. Additional Telehealth Benefits have no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, with some services requiring a copay or coinsurance. Glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and over-the-counter (OTC) hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams and a copay for Medicare-covered benefits and fitting/evaluation for hearing aids, while prescription hearing aids have a maximum benefit of $3,000 per year and OTC hearing aids have a $0 copay with a maximum benefit of $300 per year.
Vision Services See details
The Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay for routine eye exams, and eyewear with a 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, while eyeglass frames are covered with a maximum plan benefit of $400 per year. Upgrades are not covered.
Dental Services See details
Dental services are covered, with a $4,500 annual maximum. Medicare dental services have a 20% coinsurance, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay, but has a coinsurance between 0% and 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies also have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered with no copay, and a coinsurance of at most 20%. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered under the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. This plan requires prior authorization and charges the Medicare-defined cost share for tier 1, with coinsurance details available.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, meal benefits, and Medicare Community Resource Support. Acupuncture has no copay, and OTC items and meal benefits also have no copay. However, this plan does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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