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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 2025, 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 2025.
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 $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 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $6 copay for preferred generic drugs at a standard or mail order pharmacy. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance. Specialty tier drugs have a $1 copay.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for many services, such as preventive services, hearing exams, and home health services. While many services have no copay, some services have coinsurance, such as outpatient services at 20%, and inpatient hospital services with the Medicare-defined cost share.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered, but additional days and non-Medicare covered stays are not covered. You will pay the Medicare-defined cost share for tier 1, and will have to pay coinsurance.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, with a limit of 48 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP). Emergency Services have a $90 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and physical therapy and speech-language pathology services have a 20% coinsurance, while additional telehealth benefits has no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, and additional preventive services with a copay. The plan also covers Fitness Benefits and Remote Access Technologies with no copay, and covers Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following a Welcome Visit, all with 20% coinsurance. Health Education, In-Home Safety Assessments, Medical Nutrition Therapy, and several other services are not covered.
Hearing Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers hearing exams and fitting/evaluation for hearing aids with no copay and up to 20% coinsurance, and prescription hearing aids with no copay for all types, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. This plan also covers OTC hearing aids with no copay, up to $3,000 per year for prescription hearing aids, and up to $300 per year for OTC hearing aids.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay; eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, while upgrades are not covered.
Dental Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers dental services with a 20% coinsurance for Medicare Dental Services, while other dental services have a maximum benefit of $5,000 per year. 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 are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. 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 under the Wellpoint Full Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance of 0% to 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellpoint Full Dual Advantage (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 covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1, with coinsurance details available.
Other Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers acupuncture with no copay, over-the-counter (OTC) items with no copay, and a meal benefit with no copay. Other services include Medicare Community Resource Support with no copay, and are covered. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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, 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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