A non-government entity
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 $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:
Sign up for Wellcare Dual Access (HMO 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 D-SNP) prescription drug plan features an annual drug deductible of $615. For common medications, Tier 1 preferred generics start at an $18 copay and Tier 2 generics start at a $19 copay for a one-month supply at preferred pharmacies. You can maximize your savings by utilizing preferred mail order, which offers no copay for a three-month supply of Tier 1 and Tier 2 drugs. For brand-name and specialty medications, Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance. Tier 4 non-preferred drugs have a $100 copay for a one-month supply at both preferred and standard pharmacies. Finally, Tier 6 select care drugs offer the lowest cost option with no copay for all supply lengths at preferred pharmacies and through preferred mail order.
Additional Benefits
The Wellcare Dual Access (HMO D-SNP) offers robust medical coverage with predictable costs, generally featuring no copay and a 20% coinsurance for primary care, specialists, outpatient hospital services, and medical equipment. Inpatient hospital stays require a copay of $2,225 per stay for acute care and $2,080 for psychiatric care, with no coinsurance. Emergency care is covered with a $115 copay, while skilled nursing facility stays are covered with no copay for days 1 to 20 and 71 to 100. Beneficiaries also enjoy dental, vision, and hearing benefits, including preventive and comprehensive dental care with no copay or coinsurance. Home health services, acupuncture, and over-the-counter items are also covered with no copay and no coinsurance. Additionally, Medicare Part B insulin is available with a $35 copay and no coinsurance, making daily health management highly affordable.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Dual Access (HMO D-SNP) with a $2,225 copayment per stay for acute care and a $2,080 copayment per stay for psychiatric care, both with no coinsurance. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Wellcare Dual Access (HMO D-SNP) are covered 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 for 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, requiring prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Wellcare Dual Access (HMO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and a waiver if admitted within 24 hours. 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) primary care, specialist, therapy, and mental health services are covered with no copay and 20% coinsurance, while podiatry services are not covered. Chiropractic services are partially covered, offering routine care with no copay and no coinsurance but excluding other chiropractic services, and telehealth benefits are available with a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Wellcare Dual Access (HMO D-SNP) preventive services are partially covered, featuring annual physical exams, fitness benefits, alternative therapies, and remote access technologies with no copay and no coinsurance, alongside kidney education and other screenings with no copay and a 20% coinsurance. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Dual Access (HMO D-SNP) offers partially covered hearing services, excluding OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids. Covered routine exams require a 20% coinsurance and no copay, while fitting evaluations and eligible prescription hearing aids, up to $750 per ear annually, have no copay, no coinsurance, and no deductible.
Vision Services See details
Vision services are partially covered by Wellcare Dual Access (HMO D-SNP), excluding other eye exam services but offering one routine eye exam per year and eyewear with no copays, a 20% coinsurance, and no deductibles. Covered eyewear, such as contact lenses and eyeglasses, is subject to a $200 annual maximum benefit, and prior authorization is required for these services.
Dental Services See details
Dental services are partially covered by Wellcare Dual Access (HMO D-SNP), featuring no copay and 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive dental services. Orthodontics is not covered by the plan, and prior authorization is required for most covered dental procedures.
Home Infusion bundled Services See details
Wellcare Dual Access (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance and no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Dual Access (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Dual Access (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic supplies. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access (HMO D-SNP) covers diagnostic and radiological services with no copay, subject to a 20% coinsurance and prior authorization. This coinsurance applies to all diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient 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
Wellcare Dual Access (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay, though standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 71 to 100, while days 21 to 70 require a $218 daily copay, with no coverage for additional days beyond the Medicare-covered limit.
Other Services See details
Wellcare Dual Access (HMO D-SNP) covers other services with no copay and no coinsurance, including up to 12 acupuncture treatments yearly, over-the-counter items, and chronic illness meal benefits. Prior authorization is required for acupuncture, a referral is required for meals, and highly integrated services for dual eligible SNPs 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