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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 used. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, the premium is $72.30.
Additional Benefits
The Wellcare Dual Access (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1,945 copay per admission, while outpatient services, including mental health and substance abuse, typically involve a 20% coinsurance. Emergency services have a $110 copay, and primary care services are covered with a 20% coinsurance. Preventive services, such as an annual physical exam, have no copay, and hearing and vision services are included with a coinsurance of at most 20% and no copay for many services. Dental services are extensive, with many services offered with no copay and 20% coinsurance. Additional benefits include ambulance services with a 20% coinsurance, home health services with no copay, and coverage for home infusion and medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including both acute and psychiatric care, are covered with a copay of $1,945 per admission or stay. Additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a 20% coinsurance and no copay, observation services with a 20% coinsurance, and outpatient substance abuse services with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Wellcare Dual Access (HMO D-SNP) plan, but prior authorization is required. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Access (HMO D-SNP) plan. All Ambulance Services have no copay, but require a 20% coinsurance for both ground and air ambulance services. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Coverage, have a $110 copay and no coinsurance. Worldwide Urgent Coverage also has a $110 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access (HMO D-SNP) plan covers primary care services with a 20% coinsurance. Chiropractic services, occupational therapy, and physical therapy services are covered with a 20% coinsurance, while routine chiropractic care has no copay. Physician specialist, mental health, other health care professional, psychiatric services, and additional telehealth benefits are covered with a 20% coinsurance, and telehealth has a copay between $0 and $45. Opioid treatment program services are covered with a 20% coinsurance, while podiatry services are not covered.
Preventive Services See details
The Wellcare Dual Access (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit have a 20% coinsurance.
Hearing Services See details
Wellcare Dual Access (HMO D-SNP) covers hearing exams with a coinsurance of at most 20% for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids; routine hearing exams and fitting/evaluation for hearing aids are each limited to one visit per year. The plan also covers prescription hearing aids with a maximum benefit of $750 per year, and no copay for prescription hearing aids (all types), but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are 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 copays for some services. The plan offers no copay for routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Wellcare Dual Access (HMO D-SNP) plan covers Medicare Dental Services with a 20% coinsurance, and other dental services with no copay for oral exams, dental x-rays, other diagnostic services, prophylaxis, fluoride treatment, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by 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 is covered by the Wellcare Dual Access (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Equipment has a 20% coinsurance and no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, and radiological services are covered. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of at most 20%, and 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 covered by the Wellcare Dual Access (HMO D-SNP) plan, but the plan does not cover any of the specific sub-services. There is coinsurance for these services, but the specific amount is not provided.
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 and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Wellcare Dual Access (HMO D-SNP) plan covers acupuncture with no copay, up to 12 treatments per year, and over-the-counter (OTC) items with no copay, including nicotine replacement therapy and Naloxone. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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