A non-government entity
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 2025, 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 Statewide in DE. The overall rating for this plan is not yet available for 2025.
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 $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 $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:
Sign up for Wellcare Dual Access (HMO-POS D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Dual Access (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly premium for Part D drugs will be $27.50. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy type until your total drug costs reach $2,000. Once you reach $2,000 in out-of-pocket drug costs, you will enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1,710 copay per admission, while outpatient services typically involve a 20% coinsurance. Emergency services have copays, and you'll pay a 20% coinsurance for primary care and specialist visits. Preventive services include no copay for annual physical exams, and hearing and vision services are covered with coinsurance and some copays. Dental services, including exams and cleanings, are covered with no copay for many services but have limitations, and orthodontia is covered up to a $2,000 annual maximum. The plan also covers home health and ambulance services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. The plan has a copay of $1,710 per admission or stay for a Medicare-covered stay and does not charge cost sharing on the day of discharge. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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. The plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, with no copay for ambulance services. Ground and air ambulance services have a 20% coinsurance, while 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 Access (HMO-POS D-SNP), with copays of $110, $45, and $110 respectively, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers primary care physician services with a 20% coinsurance. Chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are also covered, each with a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, with 20% coinsurance. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids are covered. Routine hearing exams have a 20% coinsurance, and fitting/evaluation for hearing aids has no copay, while prescription hearing aids have a maximum benefit of $500 per year, with no copay. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay. Eyewear is covered with a 20% coinsurance, and the plan offers a combined maximum of $500 per year for eyewear, with a copay for some eyewear services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. Other Dental 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 and fixed), and oral and maxillofacial surgery with no copay, but are limited in the number of visits and periodicity. Orthodontic services are covered up to a maximum of $2000 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. Coverage also includes Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment is covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Dual Access (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 Access (HMO-POS D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers over-the-counter items with no copay, and meal benefits with no copay, but requires a doctor referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and a variety of other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved