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Wellcare Dual Access (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (HMO-POS 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-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in MI. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Dual Access (HMO-POS 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-POS 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-POS 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-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. 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:
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Drug Coverage
The Wellcare Dual Access (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply at preferred pharmacies, with no copay for a three-month supply through preferred mail order. Additionally, Tier 6 select care drugs offer maximum savings with no copay for all fulfillment methods and supply lengths. For Tier 3 preferred brand drugs, members pay a $47 copay for a one-month supply at both preferred and standard pharmacies. Higher-tier medications transition to coinsurance, with Tier 4 non-preferred drugs requiring a 42% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance for a one-month supply.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers comprehensive healthcare coverage, generally featuring no copays and a 20% coinsurance for outpatient care, doctor visits, diagnostic services, and medical equipment. Inpatient hospital stays require a $2,200 copay per admission for acute care and a $2,080 copay for psychiatric care, while skilled nursing facilities require no copay for days 1 through 20. Emergency services are covered with a $115 copay, and urgent care has a $40 copay, both of which are waived if you are admitted. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental services with no copay up to a $4,000 annual maximum. Additionally, members enjoy no copays for routine eyewear up to a $400 limit, hearing aids up to $1,500 per ear annually, and up to 24 one-way transportation trips to plan-approved locations. Over-the-counter items, home health services, and chronic illness meals are also covered with no copay, helping you manage your health and wellness affordably.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Dual Access (HMO-POS D-SNP) with no coinsurance, requiring a $2,200 copayment per admission for acute care and a $2,080 copayment per admission for psychiatric care. Prior authorization is required for these services, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access (HMO-POS 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 most of these services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Wellcare Dual Access (HMO-POS 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-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers emergency services with a $115 copay and urgent care with a $40 copay, both featuring no coinsurance and waived if admitted within 24 hours. Worldwide emergency and urgent services 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-POS D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and a 20% coinsurance, though prior authorization is required for most. Additional telehealth benefits are available with a $0 to $40 copay and 20% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), offering no copay and no coinsurance for annual physicals, fitness benefits, and alternative therapies, while kidney education and other screenings require no copay and a 20% coinsurance. Sub-services that are not covered under this plan include health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional 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-POS D-SNP) covers hearing services, including annual routine hearing exams with a 20% coinsurance and no copay, and annual fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,500 per ear every year, excluding inner ear, outer ear, over-the-ear, and OTC hearing aids.
Vision Services See details
Vision services are covered by Wellcare Dual Access (HMO-POS D-SNP), offering one annual routine eye exam with no copay and a 20% coinsurance, though other eye exam services are not covered. Covered eyewear—including eyeglasses, lenses, frames, and upgrades—has no copay or coinsurance, while contact lenses have no copay and a 20% coinsurance, up to a combined $400 annual limit.
Dental Services See details
Dental services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), featuring Medicare-covered dental with no copay and a 20% coinsurance, alongside preventive and comprehensive services with no copay and no coinsurance up to a $4,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs require 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 Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access (HMO-POS D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, 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
Diagnostic and radiological services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. Covered benefits include outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Wellcare Dual Access (HMO-POS D-SNP) feature no copay, but the benefit is not covered in practice because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and days 71 through 100, but requiring a $218 daily copay for days 21 through 70. Prior authorization is required, and additional days beyond the 100 Medicare-covered days are not covered.
Other Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers select other services with no copay and no coinsurance, including over-the-counter (OTC) items and chronic illness meal benefits, though a referral is required for meals. Acupuncture and other extra services under this benefit category are not covered.
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