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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 Select Counties in TX. This plan received an overall rating of 3.5 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 $13.90. 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 Wellpoint Full Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. During the initial coverage phase, you will pay the cost of your drugs, and the specific cost will depend on the drug tier and pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs. If you qualify for the low-income subsidy, you'll pay $13.90.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers a wide array of benefits. Many services have no copay, including home health services, annual physical exams, vision and dental services, hearing aids, and more. This plan includes coverage for inpatient and outpatient services, with varying coinsurance for some services. Emergency services, transportation, and other services are also covered with specific copays or coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but the coinsurance details are not specified. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance, and Outpatient Substance Abuse Services with a 20% coinsurance. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under 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
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers ambulance and transportation services. 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 60 one-way trips per year.
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 $90 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance. Podiatry Services have a 20% coinsurance, and Medicare-covered podiatry services have no copay. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic care is not covered.
Preventive Services See details
Preventive services, including an annual physical exam, are covered by this plan. The annual physical exam has no copay. Other preventive services may have a copay, and the plan covers glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids, while prescription hearing aids have a maximum benefit of $3,000 per year with no copay for all types of hearing aids, and OTC hearing aids have no copay with a maximum benefit of $300 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers vision services, including eye exams with 20% coinsurance, and eyewear. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, but upgrades are not covered.
Dental Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $5,500 per year. Oral exams, dental x-rays, and other diagnostic, preventative, restorative, and orthodontic services have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan, with prior authorization required. This includes Medicare Part B insulin drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%; all services have no copay.
Home Health Services See details
Home Health Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. The coinsurance information is described elsewhere.
Other Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers acupuncture with no copay, over-the-counter items with no copay, and a meal benefit with no copay. The plan also covers other services, including Medicare Community Resource Support, with no copay. Some services are not covered including 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.
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