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Wellcare Dual Reserve (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (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 Reserve (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Reserve (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 2025.
It's important to know that Wellcare Dual Reserve (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 Reserve (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 Reserve (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 Reserve (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.20. 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 Wellcare Dual Reserve (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $51.20.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers a range of benefits with varying costs. This plan covers inpatient hospital stays, outpatient services, and emergency services with copays ranging from $0 to $300. Other covered services include primary care, preventive services, hearing, vision, dental, and home health services with no or low copays, as well as specific services with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, the copay is $2036. Additional Days for Inpatient Hospital-Acute are covered with no copay for days 91-120, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $300, Observation Services have a copay between $110 and $300, Ambulatory Surgical Center (ASC) Services have a $250 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $25.00. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan with a copay of $80.00, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Ground and air ambulance services have a $285 copay, and transportation services to a plan-approved health-related location have no copay for up to 24 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Emergency Services have a $110 copay with no coinsurance, while Urgently Needed Services have a $25 copay with no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage both have a $110 copay with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $15 copay, and specialist services with a $15 copay. Mental health services, podiatry services, other health care professional services, psychiatric services, physical therapy, and additional telehealth benefits are also covered with varying copays. Opioid Treatment Program Services are covered with a $15 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Alternative Therapies with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services include no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing exams are covered with a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered, with a maximum plan benefit of $1500 per year, per ear. OTC hearing aids, and prescription hearing aids for the inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$15, and eyewear with no copay. Eyewear has a combined maximum benefit of $400 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventative services with no copay. The plan also covers orthodontic services with a $2,000 maximum benefit per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $45 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-60, the copay is $214, and for days 61-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan's "Other Services" benefit includes Over-the-Counter (OTC) Items with no copay, and Meal Benefits with no copay. 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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