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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 $8.20. 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. After meeting the deductible, your cost-sharing for drugs in each tier will apply until your total drug costs reach $2,000. If you qualify for the low-income subsidy (LIS), you will pay $8.20 for your Part D drugs. Once your yearly out-of-pocket drug costs reach $2,000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan offers a range of benefits with varying cost structures. Inpatient hospital services are covered, with the cost share defined by Medicare, while outpatient services and ambulance services have coinsurance requirements. The plan also includes coverage for hearing, vision, and dental services, with varying copays and coinsurance depending on the specific service. Preventive, primary care, and home health services are included, some with no copay or coinsurance. Additionally, the plan offers other services such as medical equipment, diagnostic services, and dialysis services, each with its own cost-sharing arrangement. Emergency services have a copay, while certain other services such as acupuncture, OTC items, and a meal benefit have no copay.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered, but additional days, non-Medicare-covered stays, and upgrades for both are not covered. For inpatient hospital services, you will pay the Medicare-defined cost share for tier 1 and prior authorization is required.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services and observation services, both with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, with a coinsurance of 20%. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay.
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
The Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan covers Primary Care Physician, Chiropractic, Occupational Therapy, Physician Specialist, Mental Health, Podiatry, Other Health Care Professional, Psychiatric, Physical Therapy and Speech-Language Pathology, Additional Telehealth, and Opioid Treatment Program services. Primary Care Physician, Chiropractic, Physician Specialist, Physical Therapy and Speech-Language Pathology, and Opioid Treatment Program services have a 20% coinsurance. Occupational Therapy, Individual and Group Mental Health, Individual and Group Psychiatric, and Other Health Care Professional services also have a 20% coinsurance. Podiatry services have a 20% coinsurance and no copay. Additional Telehealth services have no copay.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and other preventive services that may have a copay or 20% coinsurance depending on the service. Health education, in-home safety assessment, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine exams, and a $0 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 and a maximum benefit of $300 per year. Prescription hearing aids are partially covered, with inner ear, outer ear, and over the ear hearing aids not covered.
Vision Services See details
The Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance for routine eye exams, and eyewear with a 20% coinsurance for contact lenses and no copay for routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance and other services up to a $5,000 annual maximum. 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, all of which require prior authorization. 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 these services.
Medical Equipment See details
Medical Equipment benefits for the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan cover Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellpoint Full Dual Advantage 2 (HMO D-SNP) plan. 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%; all services have no copay.
Home Health Services See details
Home Health Services are covered by 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. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, a meal benefit, and Medicare Community Resource Support. Acupuncture has no copay and requires prior authorization, while OTC items and the meal benefit also have no copay. The 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, 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, and Self-Directed Personal Assistance Services.
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