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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 2026, 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 2026.
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 $27.50. 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 Wellcare Dual Reserve (HMO-POS D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply, with no copay required for three-month supplies filled through preferred mail order. Additionally, Tier 6 select care drugs are highly affordable, requiring no copay across all pharmacy types and supply durations. For higher-tier medications, Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance. Tier 4 non-preferred drugs carry a copay starting at $100 for a one-month supply at both preferred and standard pharmacies. Choosing a preferred pharmacy or preferred mail order option generally offers the lowest out-of-pocket costs for generic prescriptions under this plan.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits and preventive services. For specialized care, members pay predictable copays, such as $15 for specialists and a $300 daily copay for the first five days of inpatient hospital stays. Emergency care is available with a $115 copay, which is waived if you are admitted to the hospital. This plan also provides robust supplemental benefits with no copay, including routine dental care up to a $2,000 annual limit and routine vision and hearing exams. Additionally, members can take advantage of a $400 annual eyewear allowance, up to $1,500 per ear for hearing aids, and up to 24 one-way transportation trips per year with no copay. Over-the-counter items and chronic illness meal benefits are also covered with no copay.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers inpatient acute hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 5 and no copay for days 6 through 120. Inpatient psychiatric care is also covered with no coinsurance and a $2,036 copay per stay, although upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers outpatient services with no coinsurance, featuring copays of $0 to $300 for outpatient hospital services and $250 for ambulatory surgical center services. Outpatient substance abuse services have a $25 copay per session with no coinsurance, while outpatient blood services require no copay or coinsurance.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers ground and air ambulance services with a $350.00 copay and no coinsurance, subject to prior authorization. Plan-approved transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year, though transportation to any non-approved health-related location is not covered.
Emergency Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum limit with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and opioid treatment services require a $15 copay and no coinsurance. Mental health and psychiatric sessions carry a $25 copay with no coinsurance, telehealth benefits range from no copay to a $25 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) provides partially covered preventive services, offering an annual physical exam, fitness benefits, alternative therapies, and diabetes training with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while sub-services such as health education, weight management, nutritional therapy, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to $1,500 per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers vision services, offering eye exams with a $0 to $15 copay and no coinsurance, which includes one routine exam per year with no copay, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $400 annual combined maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers dental services, offering Medicare-covered dental with a $15 copay and no coinsurance, and preventive and comprehensive services with no copay and no coinsurance up to a $2,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay, subject to a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with prior authorization, featuring no coinsurance for diagnostic services, no copay for lab services, and a $0 to $20 copay for diagnostic procedures. For radiological services, members pay no copay for diagnostic radiology, a $45 copay for outpatient X-rays, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) indicates some services are covered with no coinsurance, but in practice, several sub-services are not covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry copayments ranging from $20.00 to $40.00.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers skilled nursing facility services with no coinsurance, requiring no copay for days 1 to 20 and 71 to 100, and a $218 daily copay for days 21 to 70. Prior authorization is required, a prior three-day hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other additional services are not covered.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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