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Wellcare Dual Reserve (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (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 Reserve (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Reserve (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 Reserve (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 Reserve (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 Reserve (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 Reserve (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 $4200.00 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 Reserve (HMO-POS D-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, copayments start as low as $18 and $19 respectively for a one-month supply at preferred pharmacies, with no copay for a three-month supply when using preferred mail order. Select care drugs in Tier 6 are highly accessible, featuring no copay at preferred pharmacies or through preferred mail order. Higher-tier medications, such as Tier 3 preferred brands and Tier 5 specialty drugs, require a 25% coinsurance. Tier 4 non-preferred drugs are subject to a $100 copay for a one-month supply at both preferred and standard pharmacies. Choosing preferred pharmacies and mail-order services helps plan members minimize their out-of-pocket prescription expenses.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers comprehensive medical coverage with affordable cost-sharing, including no copay or coinsurance for primary care visits, routine preventive services, and home health care. Specialist visits require a low $25 copay, while inpatient hospital stays feature no coinsurance and a $350 copay for the first seven days. Emergency care is available with a $150 copay, whereas urgently needed services require no copay. Members also benefit from robust dental, vision, and hearing coverage, featuring no copay or coinsurance for routine exams, preventive dental care, and comprehensive dental services. Additionally, the plan provides valuable allowances, including up to $1,000 per ear annually for prescription hearing aids, a $300 annual limit for eyewear, and no-copay over-the-counter items. Transportation is also supported with up to 12 one-way trips per year to plan-approved locations at no cost.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 copay for days 1 to 7 and no copay for days 8 to 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no coinsurance, featuring a $0 to $225 copay for outpatient hospital services and a $150 to $225 copay for observation services. Ambulatory surgical center services require a $175 copay with no coinsurance, outpatient substance abuse sessions have a $40 copay with no coinsurance, and outpatient blood services are provided with no copay or coinsurance.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), as transportation to any health-related location is not covered. Covered ground and air ambulance services require a $270 copay and no coinsurance, while up to 12 one-way trips per year to plan-approved locations are available with no copay and no coinsurance.
Emergency Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum limit with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers primary care physician services with no copay and no coinsurance, and specialist, therapy, and opioid treatment services with a $25 copay and no coinsurance. Mental health, psychiatric, and telehealth services require copays up to $40 and no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) provides preventive services with no copay and no coinsurance for annual physical exams, glaucoma screenings, diabetes self-management, digital rectal exams, post-welcome-visit EKGs, alternative therapies, fitness benefits, PERS, and remote access technologies. Kidney disease education is covered with no copay and a 20% coinsurance. However, the benefit is only partially covered, as health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary services, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) provides partially covered hearing services, featuring Medicare-covered exams for a $25 copay and no coinsurance, plus annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), featuring no copay and no coinsurance for routine eye exams and eyewear, though other eye exam services are not covered. Members receive one routine exam per year and a $300 annual maximum for eyewear, including lenses, frames, and contacts, with prior authorization required.
Dental Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) offers partially covered dental services, featuring no copay and no coinsurance for most preventive and comprehensive services, while Medicare-covered dental services require a $25 copay and no coinsurance. 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 Reserve (HMO-POS D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay under specified manufacturer limits, and prior authorization is required for most services.
Diagnostic and Radiological Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $50 copay for diagnostic procedures. Covered radiological services include diagnostic radiology with no minimum copay, outpatient X-rays with a $35 copay and coinsurance, and therapeutic radiology with a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers some cardiac rehabilitation services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require copays ranging from $30 to $65.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1-20 and 41-100, and a $218 daily copay for days 21-40. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) provides partial coverage for other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit, and a referral is required to access the meal benefit.
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