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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 New Jersey. This plan received an overall rating of 3 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 $32.10. 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:
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Drug Coverage
The Wellpoint Full Dual Advantage (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This applies to one-month, two-month, and three-month supplies, helping you save on essential daily medications. For other medication tiers, including Tier 3 preferred brand, Tier 4 non-preferred drug, and Tier 5 specialty tier, you will pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacies and standard mail order services for up to a three-month supply, except for specialty drugs which are limited to a one-month supply. This structure helps you easily project your out-of-pocket prescription costs.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers comprehensive coverage for core medical needs, often with no copay and no coinsurance. Key benefits such as inpatient hospital stays, primary care visits, specialist consultations, home health care, skilled nursing facility stays, and ambulance services are fully covered at no cost to you. Additionally, members can access preventive services like annual physical exams and select extra benefits, including fitness programs and over-the-counter items, with no copay or coinsurance. For other services, including outpatient hospital care, diagnostic tests, dialysis, and Medicare-covered dental, vision, and hearing exams, the plan generally features no copay but requires a 20% coinsurance. Urgent and emergency care are subject to copays of $40 and $115 respectively, while Medicare Part B insulin is available with a $35 copay. It is important to note that routine dental, routine vision, and hearing aids are not covered under this plan.
Inpatient Hospital See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization is required. These services are partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Wellpoint Full Dual Advantage (HMO D-SNP) generally feature no copay, but most services—including outpatient hospital, observation, ambulatory surgical center, and individual or group substance abuse sessions—require prior authorization and a 20% coinsurance. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers ground and air ambulance services with no copay and no coinsurance, although prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a $100,000 maximum plan benefit limit.
Primary Care See details
Wellpoint Full Dual Advantage (HMO D-SNP) offers primary care provider, specialist, and telehealth services with no copay and no coinsurance. Physical, occupational, mental health, and psychiatric services are covered with no copay and a 20% coinsurance, while podiatry is 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, while other preventive services like glaucoma screenings and diabetes self-management training have no copay and a 20% coinsurance. Additional preventive services are partially covered, offering fitness benefits, remote access technologies, home safety modifications, and personal emergency response systems with no copay and no coinsurance, though sub-services like health education and nutritional benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP), offering covered hearing exams with no copay, no coinsurance, and no deductible, though prior authorization is required. However, routine hearing exams, hearing aid fitting and evaluations, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no deductible, no copay, and 20% coinsurance, though in practice, routine eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) provides partial coverage for dental services, covering only Medicare-covered dental care with no copay and a 20% coinsurance, which requires prior authorization. Other routine and comprehensive dental services, including exams, cleanings, x-rays, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, 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 by 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 durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required. Covered services include outpatient diagnostic procedures, lab work, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) provides coverage for cardiac rehabilitation services with no copay and prior authorization required, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, and do not require a prior three-day inpatient hospital stay. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance for acupuncture, over-the-counter items, and Medicare Community Resource Support. Meal benefits are not covered under this plan.
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