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Wellpoint Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Full Dual Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Full Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Wellpoint Full Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Tennessee. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellpoint Full Dual Advantage (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:
Wellpoint Full Dual Advantage (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 Wellpoint Full Dual Advantage (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 Wellpoint Full Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.10. 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 Wellpoint Full Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy. If you qualify for the low-income subsidy, you will pay $15.10 for Part D. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing options. Many services, like primary care, outpatient services, vision, and dental, have coinsurance of 20%. Emergency services have a $110 copay, and partial hospitalization has a $55 copay. This plan provides additional coverage, including no copay for preventive services like annual physical exams and routine eye exams, along with no copays for hearing aid fitting/evaluation, prescription hearing aids up to $3,000, OTC hearing aids up to $300, and many dental services. The plan also includes coverage for home health services and medical equipment with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan, but additional days and non-Medicare-covered stays are not covered. The plan requires prior authorization and has coinsurance, with more details available in the plan documents.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, both with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Services have a $0 copay.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Other Health Care Professional have a 20% coinsurance. Chiropractic Services and Routine Foot Care have a 20% coinsurance and Routine Chiropractic Care has no copay. Mental Health Specialty Services and Psychiatric Services have a 20% coinsurance for individual and group sessions. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit with 20% coinsurance. Health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered. Additional services like fitness benefits, remote access technologies, home and bathroom safety devices and modifications, and kidney disease education services are covered with no copay.
Hearing Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers hearing services, including routine hearing exams with a 20% coinsurance for some services, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay up to a maximum of $3000 per year, and OTC hearing aids are covered with no copay up to a maximum of $300 per year. Some prescription hearing aid services are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, and eyeglass lenses, has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have no copay.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. This plan offers a $5,500 maximum benefit per year for other dental services, and has no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay for these services, but you may have to pay up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered days or non-Medicare-covered stays. Prior authorization is required, and you will pay the Medicare-defined cost share for tier 1.
Other Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers over-the-counter items and meal benefits with 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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