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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 TX. This plan received an overall rating of 3.5 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 $4.80. 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 $500.00 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) prescription drug plan features an annual drug deductible of $500. For Tier 1 preferred generics and Tier 2 generics, you can expect 1-month copays starting at $18 and $19 at preferred pharmacies, or no copay for a 3-month supply filled through preferred mail order. Tier 6 select care drugs also feature no copay at preferred pharmacies and preferred mail order. Brand-name and specialty medications under this plan require coinsurance rather than flat copays. You will pay a 20% coinsurance for Tier 3 preferred brands, a 39% coinsurance for Tier 4 non-preferred drugs, and a 25% coinsurance for Tier 5 specialty drugs. Choosing preferred pharmacies and preferred mail order delivery is the most cost-effective way to fill your prescriptions under this plan.
Additional Benefits
The Wellcare Dual Access (HMO D-SNP) plan offers comprehensive medical coverage, with many outpatient, diagnostic, and specialist services requiring no copay and a 20% coinsurance. Inpatient hospital stays require a $1,980 copay per admission with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Primary care and specialist visits feature no copay and a 20% coinsurance, while home health care is fully covered with no copay and no coinsurance. Additional benefits include preventive and comprehensive dental care with no copay and no coinsurance up to a $3,000 annual limit. Routine vision and hearing exams feature no copay and a 20% coinsurance, alongside allowances of up to $300 yearly for eyewear and $750 per ear for hearing aids with no copay or coinsurance. You also receive up to 36 one-way trips to plan-approved locations and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Dual Access (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,980 copayment per admission and no coinsurance, though prior authorization is required. This benefit is partially covered as additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Wellcare Dual Access (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical, and substance abuse services, and the deductible is waived for the first three pints of outpatient blood.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellcare Dual Access (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required before you can receive this care.
Ambulance and Transportation Services See details
Wellcare Dual Access (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay, while transportation services are partially covered. Transportation to plan-approved locations is covered with no copay and no coinsurance for up to 36 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered under the Wellcare Dual Access (HMO D-SNP) plan with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgent care is available for a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum 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, and mental health services with no copay and 20% coinsurance, while podiatry features no copay and no coinsurance. Chiropractic services are partially covered, excluding routine and other chiropractic care, and telehealth benefits are offered with a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Wellcare Dual Access (HMO D-SNP) provides partially covered preventive services, offering annual physical exams, fitness benefits, and alternative therapies with no copay and no coinsurance, while excluding options like health education and in-home safety assessments. Kidney disease education and specific screenings, such as glaucoma and diabetes self-management, are covered with no copay and 20% coinsurance.
Hearing Services See details
Wellcare Dual Access (HMO D-SNP) covers hearing services with no deductible, featuring routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear annually, but OTC, inner-ear, outer-ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Wellcare Dual Access (HMO D-SNP) offers partially covered vision services, excluding other eye exam services, with no deductibles and prior authorization required. One routine annual eye exam is covered with no copay and a 20% coinsurance, and eyewear is covered up to $300 yearly with no copay or coinsurance for eyeglasses, lenses, frames, and upgrades, and a 20% coinsurance with no copay for contact lenses.
Dental Services See details
Wellcare Dual Access (HMO D-SNP) dental services are partially covered, offering Medicare-covered dental with no copay and a 20% coinsurance, and preventive and comprehensive dental with no copay and no coinsurance up to a $3,000 annual maximum. Prior authorization is required for most services, and maxillofacial prosthetics, implant services, and orthodontics are 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, radiation, and other drugs carry a 0% to 20% coinsurance, while Medicare 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 15% coinsurance.
Medical Equipment See details
Wellcare Dual Access (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these services, 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, including lab tests, x-rays, and therapeutic radiology, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Home health services are covered by Wellcare Dual Access (HMO D-SNP) with no copay and no coinsurance, though 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 symptomatic 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, though prior authorization is required. There is no copay for days 1 through 20 and days 71 through 100, a $218 daily copay for days 21 through 70, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Dual Access (HMO D-SNP) provides coverage for select other services, including over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance, although a referral is required for meals. Acupuncture and highly integrated services are not covered under this plan.
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