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Wellcare Dual Access (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Access (HMO D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Access (HMO D-SNP) is a HMO D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in PA. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Dual Access (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:
Wellcare Dual Access (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 Wellcare Dual Access (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 Wellcare Dual Access (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $33.40. 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 Wellcare Dual Access (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. The plan's formulary provides more details on the specific drugs covered and their associated costs. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $33.40. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs, though you may still pay for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Wellcare Dual Access (HMO D-SNP) plan offers a wide range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with a 20% coinsurance, and emergency services with a copay. The plan also includes coverage for primary care services, preventive services, hearing and vision services, dental services, and home infusion services, with varying cost-sharing structures like coinsurance and copays. Additional covered services include ambulance and transportation, dialysis, medical equipment, diagnostic and radiological services, home health, cardiac rehabilitation, and skilled nursing facility care. Many services have no copay, such as transportation, hearing exams, and home health, while others, like inpatient hospital stays, have a fixed copay. Some services, such as those for dental and home health, have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $1,695 per admission or stay for Inpatient Hospital-Acute and a copay of $1,750 per admission or stay for Inpatient Hospital Psychiatric. Additional Days, Non-Medicare-covered Stays, and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a 20% coinsurance and no copay, observation services with a 20% coinsurance, ambulatory surgical center (ASC) services with a 20% coinsurance, outpatient substance abuse services with a 20% coinsurance, and outpatient blood services with a 20% coinsurance. This plan waives the three-pint deductible for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Access (HMO D-SNP) plan, including both ground and air ambulance services, each with a 20% coinsurance, and transportation services with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered under the Wellcare Dual Access (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Urgent Coverage also has a $110 copay and no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, with Additional Telehealth Benefits also having a copay between $0 and $45. Chiropractic Services and Individual and Group Sessions for Mental Health and Psychiatric Services also have a 20% coinsurance. The plan does not cover Podiatry Services, and Routine Chiropractic Care is also not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, and other services with a 0 dollar copay for Fitness Benefit, Personal Emergency Response System (PERS), Alternative Therapies, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline). You will pay 20% coinsurance for Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing exams are covered, including routine hearing exams with no copay and a coinsurance of at most 20%, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with no copay and a maximum plan benefit of $1,000 per year. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a 20% coinsurance, with no copay, and routine eye exams have no copay. Eyewear has a 20% coinsurance, with no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. Other services include 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, implant services, prosthodontics, fixed, and oral and maxillofacial surgery, all with no copay. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Dual Access (HMO D-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Access (HMO D-SNP) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is also covered, with 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of at most 20%, and Lab Services have a coinsurance of at most 20% with no copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access (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 not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is coinsurance for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access (HMO D-SNP) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Wellcare Dual Access (HMO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits, with no copay for either. Acupuncture, 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 are not covered.
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