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Wellcare Dual Access (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (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 Access (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Access (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 WI. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Dual Access (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 Access (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 Access (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 Access (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.90. 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 $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 Dual Access (HMO-POS D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs depending on the tier and pharmacy you use until your total drug costs reach $2000.00. If you qualify for the low-income subsidy, you may have a reduced premium. Once your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers a range of benefits, including inpatient hospital stays with a $1610 copay per admission, and outpatient services with a 20% coinsurance. Emergency services have a $110 copay, and transportation to health-related locations is available with no copay. Preventive services, such as an annual physical exam, have no copay, and hearing and vision services are covered with a 20% coinsurance. Dental services offer no copay for many services, and the plan also covers home health services, and skilled nursing facility (SNF) services with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a copay of $1610 per admission or stay. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20% coinsurance and no copay, Observation Services with 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance, Outpatient Substance Abuse Services with a 20% coinsurance, and Outpatient Blood Services with a 20% coinsurance. The plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Dual Access (HMO-POS D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay, and are limited to 48 one-way trips per year via rideshare, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage all have a copay of $110, while Urgently Needed Services has a copay of $45, and there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers Primary Care Physician Services, Chiropractic Services (with a 20% coinsurance, but not for routine care), Occupational Therapy Services (with a 20% coinsurance), Physician Specialist Services (with a 20% coinsurance), Mental Health Specialty Services (with a 20% coinsurance for individual and group sessions), Other Health Care Professional services (with a 20% coinsurance), Psychiatric Services (with a 20% coinsurance for individual and group sessions), Physical Therapy and Speech-Language Pathology Services (with a 20% coinsurance), Additional Telehealth Benefits (with a 20% coinsurance and a copay between $0 and $45), and Opioid Treatment Program Services (with a 20% coinsurance). Podiatry Services are not covered.
Preventive Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additionally, the plan covers services such as glaucoma screening, diabetes self-management training, barium enemas, and digital rectal exams with a 20% coinsurance.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with a maximum coinsurance of 20% and no copay. Prescription hearing aids are covered with no copay, with a maximum plan benefit of $2,500 per year.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have no copay, but require a 20% coinsurance. Eyewear has a $500 combined maximum plan benefit coverage per year, with a 20% coinsurance.
Dental Services See details
Dental services include 20% coinsurance for Medicare dental services, and other dental services with no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Orthodontic services are covered, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics and orthodontics are not covered.
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, all requiring prior authorization.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Access (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 Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies, including Medicare-covered Prosthetic Devices and Medical Supplies, have a 20% coinsurance. Diabetic Equipment, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, also have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 20%, and lab services have a 0% copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access (HMO-POS 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 Dual Access (HMO-POS 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 by the Wellcare Dual Access (HMO-POS D-SNP) plan, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and Meal Benefits, with OTC items having no copay, while 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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