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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 2026, 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 WI. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $10.40. 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 $5100.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply at a preferred pharmacy, with no copay required for three-month supplies filled through preferred mail order. Additionally, Tier 6 select care drugs are highly affordable, offering no copay for all supply durations at preferred pharmacies and for multi-month supplies through preferred mail order. For higher-tier medications, Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance across standard and preferred networks. Tier 4 non-preferred drugs carry a copay starting at $100 for a one-month supply, which can rise to $300 for a three-month supply depending on the pharmacy and delivery method chosen. Understanding these cost-sharing tiers helps you estimate your out-of-pocket expenses when choosing this plan.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers strong healthcare coverage with no copay for primary care visits, routine preventive care, and home health services. Specialist visits and outpatient therapies require a $20 copay, while outpatient hospital services range from no copay up to a $300 copay. Inpatient hospital stays feature daily copays for the first seven days, followed by no copay for days eight through 90. Essential supplemental benefits like routine dental, vision, and hearing exams are covered with no copay, alongside allowances of up to $1,500 per ear for hearing aids and $300 annually for eyewear. Durable medical equipment, prosthetics, and dialysis services generally require no copay and a 20% coinsurance. Additionally, members benefit from covered over-the-counter items and chronic illness meal benefits with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no coinsurance, though prior authorization is required. Acute hospital stays require a $325 copay for days 1 through 7 and no copay for days 8 through 90, while psychiatric stays require a $275 copay for days 1 through 7 and no copay for days 8 through 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $300 copay and ambulatory surgical center services with a $125 copay. Outpatient substance abuse sessions require a $40 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers ambulance services with a $300 copay and no coinsurance for ground and air transport, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 lifetime maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO-POS D-SNP) offers partially covered primary care benefits, as chiropractic and podiatry services are not covered. Covered services feature no coinsurance, with no copay for primary care provider visits, a $20 copay for specialists, physical, occupational, speech, and opioid treatment therapies, and a $40 copay for mental health and psychiatric sessions. Telehealth and other healthcare professional services range from no copay up to $40 and $20 copays, respectively, with no coinsurance.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers preventive services, including annual physicals, fitness benefits, alternative therapies, and screenings, with no copay and no coinsurance, while kidney disease education requires no copay and 20% coinsurance. The benefit is partially covered because health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, home modifications, and counseling are not covered.
Hearing Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers hearing exams with a $20 copay and no coinsurance for Medicare-covered tests, while annual routine exams and fitting evaluations have no copay and no coinsurance. Hearing aids are partially covered with no copay or coinsurance up to $1,500 per ear annually, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) offers partially covered vision services with no coinsurance, featuring one annual routine eye exam with no copay, while other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, is available with no copay and no coinsurance up to a $300 annual maximum benefit.
Dental Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) dental services are partially covered, with Medicare-covered dental services requiring a $20 copay and no coinsurance, and other covered preventive and comprehensive services requiring no copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered by the plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance of 0% to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require 20% coinsurance, with prior authorization required for most medical equipment.
Diagnostic and Radiological Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic procedures with a copay ranging from $0 to $20. Radiological services require a $50 copay for outpatient X-rays, a minimum 20% coinsurance for therapeutic radiology, and no copay for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Reserve (HMO-POS D-SNP) provides partially covered skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and 51 to 100, and a $218 daily copay for days 21 to 50. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers other services, offering Over-the-Counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though a referral is required for the meal benefit. Acupuncture, other unspecified services, and highly integrated services for dual eligible SNPs are not covered.
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