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Wellcare Dual Access (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (HMO-POS 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-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in NC. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Dual Access (HMO-POS 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-POS 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-POS 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-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.20. 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 $385.00 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 Wellcare Dual Access (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $385. For maximum savings, Tier 6 select care drugs have no copay, and you can also receive a three-month supply of Tier 1 preferred generics or Tier 2 generics with no copay through preferred mail order. Standard one-month generic drug copays range from $18 to $20 depending on the tier and whether you use a preferred or standard pharmacy. For higher-tier medications, you will pay either a copayment or coinsurance. Tier 3 preferred brands and Tier 5 specialty drugs both require a 25% coinsurance, while Tier 4 non-preferred drugs have a $100 copay for a one-month supply. Utilizing preferred pharmacies and mail-order options can help lower your overall out-of-pocket prescription costs.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) offers robust medical coverage designed to manage your out-of-pocket costs. Inpatient hospital stays require a $2,000 copay per admission with no coinsurance, while primary care, specialist visits, and outpatient services generally feature no copay and a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted to the hospital, and urgent care has a $40 copay. Beyond standard medical services, this plan includes valuable dental, vision, and hearing benefits with no deductibles. Preventive and comprehensive dental care are covered up to $3,000 annually with no copay or coinsurance, alongside a $500 annual allowance for eyewear and $1,000 per ear for hearing aids. Members also benefit from no copay or coinsurance for home health services, routine podiatry visits, and over-the-counter items.
Inpatient Hospital See details
Wellcare Dual Access (HMO-POS D-SNP) covers inpatient acute and psychiatric hospital stays with a $2,000 copayment per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers outpatient services with no copayment, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Wellcare Dual Access (HMO-POS D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. The plan also partially covers transportation services, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to other health-related locations is not covered.
Emergency Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits for Wellcare Dual Access (HMO-POS D-SNP) are covered with no copay and 20% coinsurance for primary care, specialist, therapy, and psychiatric services, though chiropractic services are not covered. Podiatry services feature no copay and no coinsurance for up to six routine visits per year, while telehealth services are available with a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Preventive Services under the Wellcare Dual Access (HMO-POS D-SNP) plan are partially covered, offering annual physical exams, fitness benefits, and personal emergency response systems with no copay and no coinsurance. Other services, such as kidney disease education and glaucoma screenings, feature no copay and a 20% coinsurance, while several benefits like health education and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers hearing services with no deductible, including one annual routine hearing exam with a 20% coinsurance and no copay, and one fitting evaluation with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear every year, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Dual Access (HMO-POS D-SNP) partially covers vision services with no deductibles, excluding other eye exam services. Routine eye exams are covered once annually with no copay and 20% coinsurance, and eyewear is covered up to $500 yearly with no copay and no coinsurance, except for contact lenses which require 20% coinsurance.
Dental Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers partially covered dental services with no copay and 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive care up to a $3,000 annual limit. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access (HMO-POS D-SNP) covers durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specific manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers diagnostic and radiological services with no copayment, though a 20% coinsurance and prior authorization are required. This coverage applies to diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Access (HMO-POS D-SNP) provides coverage for cardiac rehabilitation services with no copay, though only some services are covered in practice. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 71 through 100, a $218 daily copay for days 21 through 70, and additional days beyond the standard 100 days are not covered.
Other Services See details
Wellcare Dual Access (HMO-POS D-SNP) provides partially covered other services, which include over-the-counter (OTC) items and a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and other additional services are not covered under this plan, and a referral is required for the meal benefit.
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