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Wellpoint Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Full Dual Advantage (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 (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellpoint Full Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Hidalgo and Cameron counties. 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 (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 (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 (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 (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 $20.00 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 (HMO D-SNP) prescription drug plan features an affordable annual drug deductible of $20. You will 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. This makes obtaining common generic medications highly cost-effective for plan members. For brand-name and specialty drugs, your costs are determined by coinsurance. Tier 3 preferred brand and Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail order fills. Specialty drugs in Tier 5 carry a 32% coinsurance for a one-month supply.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) offers comprehensive medical coverage, featuring no copay for inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient care, specialist visits, and diagnostic testing, members generally pay no copay alongside a 20% coinsurance. Emergency care is accessible with a $115 copay, which is waived upon hospital admission, and urgent care has a $40 copay. Supplemental benefits are a key highlight, providing up to $4,000 annually for dental care and up to $3,000 for hearing aids with no copay or coinsurance. The plan also covers up to 48 one-way trips to approved health locations and eyewear up to $300 per year with no copay. Additional everyday perks include acupuncture and over-the-counter items, both available with no copay and no coinsurance.
Inpatient Hospital See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers outpatient services with no copay, though outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services carry a 20% coinsurance and require prior authorization and referrals. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Wellpoint Full Dual Advantage (HMO D-SNP) with a $60.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance, providing up to 48 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 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with 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 benefit.
Primary Care See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, while additional telehealth benefits are available with no copay and no coinsurance. For chiropractic care, some services are covered with no copay and a 20% coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers annual physical exams and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness, PERS, remote access, and safety devices, while sub-services like health education, nutritional therapy, and in-home support are not covered. Other services, such as glaucoma screenings and diabetes training, require a referral and have no copay but carry a 20% coinsurance.
Hearing Services See details
Hearing services are covered by Wellpoint Full Dual Advantage (HMO D-SNP), featuring routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations with 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. OTC hearing aids are also covered up to $300 per year with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP), featuring one annual routine eye exam with no copay and 20% coinsurance, while other eye exams are not covered. Eyewear is covered up to a $300 annual limit with no deductible, offering contact lenses with no copay and 20% coinsurance, and eyeglasses with no copay or coinsurance, though upgrades are excluded.
Dental Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) offers partially covered dental services with an annual maximum of $4,000, featuring no copay and no coinsurance for preventive and most comprehensive care, while Medicare-covered dental requires no copay and a 20% coinsurance. Implant services, maxillofacial prosthetics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B insulin is covered under this benefit with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers medical equipment, including durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetic devices and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic procedures, therapeutic radiology, and X-rays, with no copay and a 20% coinsurance. Prior authorization and referrals are required for all of these covered services.
Home Health Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home health services 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 (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization required, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Under this plan, a prior three-day inpatient hospital stay is not required for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Wellpoint Full Dual Advantage (HMO D-SNP) are partially covered, offering acupuncture, over-the-counter items, chronic illness meal benefits, and Medicare community resource support with no copay and no coinsurance. Highly integrated dual eligible SNP services are not covered under this plan.
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