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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:
Sign up for Wellpoint Full Dual Advantage 2 (HMO D-SNP)
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Drug Coverage
The Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan features a yearly drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs purchased at standard pharmacies or through standard mail order. This applies to one-month, two-month, and three-month supplies of these medications. For other prescription tiers, costs are based on coinsurance rather than flat copayments. Members pay a 25% coinsurance for Tier 3 preferred brand and Tier 4 non-preferred drugs across all supply lengths. Tier 5 specialty drugs also carry a 25% coinsurance, which is applicable to a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for inpatient hospital stays, home health services, and skilled nursing facility care. For outpatient hospital visits, primary care, specialist consultations, and diagnostic testing, members will generally pay no copay but are subject to a 20% coinsurance. Emergency room visits require a $115 copay, which is waived if admitted, while urgent care services have a $40 copay. This plan also includes robust supplemental benefits with no deductibles, featuring up to $4,250 annually for select dental services with no copay or coinsurance. Vision and hearing benefits provide generous allowances, including up to $400 for eyewear and up to $3,000 for prescription hearing aids with no copay. Additionally, members can access up to 60 one-way trips per year for medical transportation, alongside covered over-the-counter items and chronic illness meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) partially covers inpatient hospital services, providing acute and psychiatric care with no copay and no coinsurance, subject to prior authorization. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellpoint Full Dual Advantage 2 (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance rides. Additionally, transportation is covered with no copay or coinsurance for up to 60 one-way trips per year to plan-approved health-related 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 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with no copay and no coinsurance.
Primary Care See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers primary care, specialist visits, mental health, therapy, podiatry, and opioid treatment services with no copay and 20% coinsurance. Additional telehealth benefits are covered with no copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Wellpoint Full Dual Advantage 2 (HMO D-SNP), offering annual physicals, kidney education, and select supplemental benefits with no copay and no coinsurance. Other services like glaucoma screenings and diabetes training require a referral and 20% coinsurance with no copay. Excluded sub-services include health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered by Wellpoint Full Dual Advantage 2 (HMO D-SNP) with no deductible, including one annual routine exam with a 20% coinsurance and no copay. Fitting evaluations, OTC hearing aids up to $300 annually, and prescription hearing aids up to $3,000 annually all require no copay or coinsurance, though prescription aids are partially covered since inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) partially covers vision services with no deductibles, offering one routine eye exam per year with no copay and 20% coinsurance, and eyewear up to a $400 annual limit. Covered eyewear includes eyeglasses with no copay and no coinsurance, and contact lenses with no copay and 20% coinsurance, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) partially covers dental services, featuring Medicare-covered dental with no copay and 20% coinsurance, and other dental services up to $4,250 annually with no copay and no coinsurance. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered with no copay under the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan, though prior authorization and step therapy are required. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy 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 incurs a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment is available with no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers diagnostic and radiological services, including lab services, X-rays, and therapeutic radiology, with no copay and a minimum 20% coinsurance. Prior authorization and referrals are required for all of these Medicare-covered services.
Home Health Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) states some services are covered under Cardiac Rehabilitation Services with no copay, but key sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD), 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 additional days beyond the standard Medicare-covered limit are not covered. Prior authorization is required for these services, but members do not need a prior three-day inpatient hospital stay before admission.
Other Services See details
Wellpoint Full Dual Advantage 2 (HMO D-SNP) covers other services including acupuncture, over-the-counter (OTC) items, chronic illness meal benefits, and Medicare community resource support with no copay and no coinsurance. Highly integrated services for dual eligible SNPs are not covered under this plan.
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