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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 2026, 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 out of 5 stars in 2026.
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 $58.80. 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 $410.00 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 D-SNP) plan features an annual drug deductible of $410. For Tier 6 select care drugs, there is no copay across all pharmacies and mail-order options. Generic medications are highly affordable, with Tier 1 preferred generics starting at an $18 copay and Tier 2 generics starting at a $19 copay for a one-month supply, with no copay for three-month preferred mail orders of both tiers. For brand-name and specialty medications, the plan transitions to coinsurance and higher copays. Tier 3 preferred brands require a 20% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply. Tier 4 non-preferred drugs have a flat $100 copay for a standard or preferred one-month supply.
Additional Benefits
The Wellcare Dual Access (HMO D-SNP) plan offers comprehensive medical coverage with varying cost-sharing structures. Inpatient hospital stays require a copay of either $2,230 for acute care or $2,080 for psychiatric care per stay with no coinsurance, while outpatient services, primary care, and specialist visits feature no copay and a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if admitted, while urgently needed services carry a $40 copay. Many routine and preventive services are highly affordable under this plan, offering no copay and no coinsurance for annual physicals, preventive dental cleanings, home health care, and select over-the-counter items. Routine vision and hearing exams generally feature no copay and a 20% coinsurance, with allowances of up to $200 for eyewear and $500 per ear for prescription hearing aids at no copay or coinsurance. Durable medical equipment and diagnostic services are also covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Dual Access (HMO D-SNP) partially covers inpatient hospital services, featuring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care, both with no coinsurance and requiring prior authorization. Non-Medicare-covered stays, additional days, and upgrades are not covered under these benefits.
Outpatient Services See details
Outpatient services are covered by Wellcare Dual Access (HMO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Wellcare Dual Access (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Dual Access (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Wellcare Dual Access (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access (HMO D-SNP) covers primary care, specialist, therapy, psychiatric, and mental health services with no copay and 20% coinsurance, while telehealth benefits feature a $0 to $40 copay and 20% coinsurance. Chiropractic services are partially covered with no copay and no coinsurance for routine care, but other chiropractic services and all podiatry services are not covered.
Preventive Services See details
Wellcare Dual Access (HMO D-SNP) provides partially covered preventive services, including annual physical exams, fitness benefits, remote access technologies, and alternative therapies with no copay and no coinsurance. Other covered services like kidney disease education, glaucoma screenings, and diabetes self-management training feature no copay and 20% coinsurance, while sub-services such as health education, nutritional benefits, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by Wellcare Dual Access (HMO D-SNP) with no deductible, including one routine exam per year 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 $500 per ear annually (inner ear, outer ear, and over the ear types are not covered), while over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Wellcare Dual Access (HMO D-SNP) provides partially covered vision services with no deductibles, featuring one annual routine eye exam with no copay and a 20% coinsurance, though other eye exam services are not covered. Covered eyewear, including eyeglasses and frames, has no copay and no coinsurance up to a $200 annual limit, while contact lenses require a 20% coinsurance with no copay.
Dental Services See details
Wellcare Dual Access (HMO D-SNP) offers partially covered dental services, featuring Medicare-covered dental care with no copay and a 20% coinsurance. Preventive and comprehensive services, such as cleanings, exams, and implants, are available with no copay and no coinsurance, though orthodontics is not covered.
Home Infusion bundled Services See details
Wellcare Dual Access (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access (HMO D-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Dual Access (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This coverage includes outpatient diagnostic tests, lab services, therapeutic radiological services, and X-rays.
Home Health Services See details
Home Health Services are covered by Wellcare Dual Access (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no copay under the Wellcare Dual Access (HMO D-SNP) plan, but only some services are covered, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Wellcare Dual Access (HMO D-SNP) with no coinsurance and prior authorization required, though additional days beyond the standard Medicare limit are not covered. Under this plan, there is no copay for days 1 through 20 and days 71 through 100, a $218 daily copay for days 21 through 70, and no prior three-day hospital stay is required.
Other Services See details
Other services under the Wellcare Dual Access (HMO D-SNP) plan are partially covered, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and highly integrated services for dual eligible SNPs are not covered, and the meal benefit requires a referral.
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