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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 2026, 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 2026.
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 $1.90. 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 Wellpoint Full Dual Advantage (HMO D-SNP) prescription drug plan features an annual deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, members are responsible for a 25% coinsurance for up to a three-month supply. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply at standard pharmacies and standard mail order locations.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) offers comprehensive coverage with no copays for many core services, including inpatient hospital stays, home health care, and skilled nursing facility services. For doctor visits, specialist consultations, diagnostic tests, and dialysis, you will pay no copay alongside a typical 20% coinsurance. Emergency room visits require a $115 copay, urgent care has a $20 copay, and Medicare Part B insulin is covered with a $35 copay. Additionally, this plan provides robust supplemental benefits with no copays or coinsurances, including up to $5,500 annually for dental care, a $600 annual eyewear allowance, and up to $3,000 for prescription hearing aids. Members also benefit from unlimited one-way transportation to plan-approved locations and covered over-the-counter items with no copays or coinsurances. These valuable extras make managing your everyday healthcare needs highly affordable.
Inpatient Hospital See details
Wellpoint Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellpoint Full Dual Advantage (HMO D-SNP) with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering unlimited one-way trips to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copays or coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, mental health, and podiatry services with no copay and a 20% coinsurance, while telehealth services have no copay and no coinsurance. Chiropractic care is partially covered, offering up to 48 routine visits per year with no copay and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, fitness benefits, remote access technologies, home safety devices, and personal emergency response systems. Additional preventive services are partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling. Glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs are covered with no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no deductible, offering routine hearing exams with no copay and 20% coinsurance, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $3,000 annually with no copay or coinsurance, though inner ear, outer ear, and over the ear models are not covered. Over-the-counter hearing aids are also covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP), providing one routine eye exam per year and up to $600 annually for eyewear with no deductibles or copays. Routine exams and contact lenses require a 20% coinsurance, while eyeglasses, lenses, and frames have no coinsurance; other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) partially covers dental services up to a $5,500 annual limit, offering Medicare-covered dental services with no copay and a 20% coinsurance, and other preventive and comprehensive dental services with no copay and no coinsurance. While many diagnostic, restorative, and surgical services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance with no copay, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers medical equipment with no copay, though coinsurance may apply depending on the item. Durable medical equipment carries a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. Prior authorization is required for all covered services, which include lab tests, outpatient X-rays, and therapeutic radiological procedures.
Home Health Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, although key sub-services are not covered in practice. Specifically, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit allows admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) partially covers other services, providing over-the-counter items, meal benefits for chronic illnesses, and Medicare community resource support with no copay and no coinsurance. Acupuncture and other additional services are not covered.
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