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Wellcare Dual Access (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (HMO 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 D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Access (HMO D-SNP) is a HMO D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in NY. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Dual Access (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:
Wellcare Dual Access (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 Wellcare Dual Access (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 Wellcare Dual Access (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.30. 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 Access (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for the plan will be $72.30.
Additional Benefits
The Wellcare Dual Access (HMO D-SNP) plan offers coverage for a wide range of services, including inpatient and outpatient hospital care, emergency services, and various therapies, with a mix of copays and coinsurance. Many services, such as primary care, preventive services, hearing exams, vision exams, dental services, and home health services, have no copay or a 20% coinsurance. The plan also covers home infusion services with a copay for Medicare Part B insulin drugs, and covers diagnostic and radiological services with a coinsurance. This plan covers inpatient hospital stays with a high copay, and skilled nursing facility stays with no copay for the first 20 days, and a copay for days 21-100. Ambulance and transportation services have a 20% coinsurance, while emergency services have a copay. The plan also covers over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and have a copay of $1860 per admission or stay for Medicare-covered stays. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and 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 20% coinsurance and no copay, observation services have a 20% coinsurance, and outpatient blood services have a 20% coinsurance. Individual and group sessions for outpatient substance abuse have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access (HMO D-SNP) plan with a 20% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Access (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, with no copay, while Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Coverage, are covered by the Wellcare Dual Access (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all of these services have no coinsurance. Worldwide Emergency Transportation is not covered, and Worldwide Urgent Coverage has a $110 copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with 20% coinsurance, Chiropractic Services with 20% coinsurance and no copay for routine care, Occupational Therapy Services with 20% coinsurance, Physician Specialist Services with 20% coinsurance, Mental Health Specialty Services with 20% coinsurance for individual and group sessions, Other Health Care Professional with 20% coinsurance, Psychiatric Services with 20% coinsurance for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with 20% coinsurance, Additional Telehealth Benefits with 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services with 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
Preventive services include no copay for an annual physical exam. Other preventive services, such as kidney disease education services, glaucoma screenings, and diabetes self-management training, have a 20% coinsurance.
Hearing Services See details
The Wellcare Dual Access (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance and a copay for certain services. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The Wellcare Dual Access (HMO D-SNP) plan covers Medicare dental services with 20% coinsurance, and other dental services including oral exams, dental x-rays, and cleanings with no copay. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Dual Access (HMO D-SNP) plan, with a $35 copay for Medicare Part B Insulin Drugs. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a 20% coinsurance, while prosthetics, medical supplies, and diabetic supplies and shoes/inserts also have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, and radiological services. 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 D-SNP) plan with no copay and no coinsurance. 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 D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. 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 D-SNP) plan's "Other Services" benefit covers over-the-counter (OTC) items and meal benefits. Over-the-counter items have no copay, and meal benefits also have no copay and require a doctor's referral. 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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