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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 2025, 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 2025.
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 $18.20. 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 $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 has a $590 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $19 copay at preferred pharmacies. This plan offers a Part D premium of $18.20 for those who qualify for the low-income subsidy (LIS). After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers comprehensive coverage with various copays and coinsurance amounts. Inpatient hospital stays have a $300 copay for the first six days, and then no copay. Outpatient services, primary care, and preventive services have no copay, while specialist visits, hearing exams, and vision services have low copays. This plan also includes coverage for ambulance services with a $270 copay, along with transportation for 12 one-way trips per year. The plan covers dental, home infusion, and medical equipment with no copays or a coinsurance. Other services like skilled nursing facilities, diagnostic services, and dialysis are covered, with varying copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered with prior authorization. For days 1-6, there is a $300 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $225, observation services with a copay between $125 and $225, ambulatory surgical center services with a $175 copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers all ambulance services with a $270 copay, and transportation services to plan-approved health-related locations with no copay for 12 one-way trips per year, utilizing rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Worldwide Urgent Coverage also has a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers primary care physician services with no copay, while chiropractic services have a $20 copay. Occupational Therapy Services have a $25 copay, and Physician Specialist Services have a $25 copay. Mental Health Specialty Services and Psychiatric Services have a $40 copay for individual and group sessions, and Physical Therapy and Speech-Language Pathology Services have a $25 copay. Other Health Care Professional services have copays between $0 and $25, and Opioid Treatment Program Services have a $25 copay. Additional Telehealth benefits have copays between $0 and $40. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, kidney disease education services, and other preventive services. Kidney disease education services have a 20% coinsurance, while glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit have no copay. Other services like health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, Routine Hearing Exams with no copay, Fitting/Evaluation for Hearing Aids with no copay, and Prescription Hearing Aids with no copay for all types. The plan does not cover Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, or OTC Hearing Aids.
Vision Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers vision services including eye exams with a copay between $0 and $25, and eyewear with a $0 copay, with a combined maximum of $300 per year for all eyewear. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers Medicare Dental Services with a $25 copay and other dental services, including oral exams, dental x-rays, and other diagnostic dental services with no copay, along with prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Orthodontic services are covered up to a maximum of $2000 per year, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $50, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $225, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Reserve (HMO-POS 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 not covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-50 the copay is $214, and for days 51-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services in the Wellcare Dual Reserve (HMO-POS D-SNP) plan covers over-the-counter (OTC) items and meal benefits. The OTC benefit has no copay, while the meal benefit also has no copay and requires a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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