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Wellcare Fidelis Dual Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Fidelis Dual Plus (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 Fidelis Dual Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Wellcare Fidelis Dual Plus (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 2025.
It's important to know that Wellcare Fidelis Dual Plus (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 Fidelis Dual Plus (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 Fidelis Dual Plus (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 Fidelis Dual Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.30. 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 $9350.00 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 Fidelis Dual Plus (HMO D-SNP) plan has a defined standard drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, the plan's premium is $72.30. After you pay your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00, at which point you enter the next coverage phase.
Additional Benefits
The Wellcare Fidelis Dual Plus (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have high copays, while many outpatient services, like those for substance abuse and blood services, have a 20% coinsurance. Emergency services have a copay, and primary care services have a 20% coinsurance, but preventive services like annual physical exams have no copay. The plan also covers hearing exams and hearing aids, with costs varying. Vision services include eye exams, but not eyewear. Dental services include a range of services with no copay, but other services are not covered. Home health services and skilled nursing facilities have no copay, while many other services have a coinsurance, and some are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For Inpatient Hospital-Acute, the copay is $2185 per admission or stay, and for Inpatient Hospital Psychiatric, the copay is $2036 per admission or stay. Additional Days, Non-Medicare-covered Stay, and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a 20% coinsurance and no copay, and observation services have a 20% coinsurance. Ambulatory surgical center services, individual and group sessions for outpatient substance abuse, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Fidelis Dual Plus (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance Services are covered by the Wellcare Fidelis Dual Plus (HMO D-SNP) plan, including ground and air ambulance services, both with a 20% coinsurance; however, there is no copay. Transportation Services are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency and Urgent Coverage, are covered by the Wellcare Fidelis Dual Plus (HMO D-SNP) plan. For Emergency Services and Worldwide Emergency Coverage, there is a $110 copay, and for Urgently Needed Services, there is a $45 copay; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Fidelis Dual Plus (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy, speech-language pathology, additional telehealth benefits, and opioid treatment program services. You will pay 20% coinsurance for primary care physician services, chiropractic services, occupational therapy, physician specialist services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Mental health specialty services, psychiatric services, and opioid treatment program services have a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and an annual physical exam with no copay. Additional services include Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices, and Alternative Therapies. Some services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have a 20% coinsurance.
Hearing Services See details
Hearing exams and prescription hearing aids are covered by the Wellcare Fidelis Dual Plus (HMO D-SNP) plan. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids have a maximum benefit of $350 per ear every year, and prescription hearing aids (all types) have no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams with no copay and 20% coinsurance, while eyewear benefits are not covered. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Wellcare Fidelis Dual Plus (HMO D-SNP) plan covers Medicare Dental Services with 20% coinsurance, and also covers other dental services with no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery, but not orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Fidelis Dual Plus (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, and there is a coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Fidelis Dual Plus (HMO D-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, and Lab Services have a coinsurance of at most 20% with no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Fidelis Dual Plus (HMO D-SNP) plan with no copay and no coinsurance. However, 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 Fidelis Dual Plus (HMO D-SNP) plan. While the plan covers some cardiac rehabilitation services, it does not cover any of the listed sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and Meal Benefit, with OTC items having no copay. 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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