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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 Select Counties in TX. This plan received an overall rating of 3.5 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 $2.40. 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 $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 has an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This applies to one-month, two-month, and three-month supplies, helping you save on common maintenance medications. For other medication categories, you will pay a 25% coinsurance for Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs. This 25% coinsurance applies to one-month, two-month, and three-month supplies for Tiers 3 and 4, and is limited to a one-month supply for Tier 5 specialty drugs. These clear cost-sharing details make it easier to estimate your out-of-pocket prescription costs.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) offers comprehensive medical coverage featuring no copay and no coinsurance for inpatient hospital stays, home health services, and skilled nursing facility care. For standard outpatient services, primary care, and diagnostic tests, members can expect no copay alongside a typical 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted within 24 hours, while urgently needed services require a $40 copay. This plan also provides robust supplemental benefits, including dental care with no copay and no coinsurance up to a $4,000 annual limit. Routine vision and hearing exams are covered with no copay and a 20% coinsurance, featuring allowances of up to $350 for eyewear and up to $3,000 for prescription hearing aids. Additionally, members benefit from no copay for up to 48 one-way transportation trips per year, select over-the-counter items, and acupuncture services.
Inpatient Hospital See details
Wellpoint Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric care with no copay and no coinsurance, though prior authorization is required. Some sub-services are not covered under this plan, including additional stay days, non-Medicare-covered stays, and room upgrades.
Outpatient Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers outpatient services with no copay, but 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 $60.00 copay and no coinsurance. Prior authorization is required for this service.
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, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance, offering up to 48 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Wellpoint Full Dual Advantage (HMO D-SNP) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $100,000 with no copays or coinsurance.
Primary Care See details
Primary Care services under the Wellpoint Full Dual Advantage (HMO D-SNP) are generally covered with no copay and 20% coinsurance, while additional telehealth benefits are offered with no copay and no coinsurance. Chiropractic services are not covered in practice since routine and other chiropractic services are not covered under this plan.
Preventive Services See details
Preventive services under the Wellpoint Full Dual Advantage (HMO D-SNP) are partially covered, providing annual physical exams, kidney disease education, and select supplemental benefits like fitness and home safety with no copay and no coinsurance. Some preventive services, such as glaucoma screenings and diabetes self-management training, require a referral and have a 20% coinsurance with no copay, while sub-services like health education, nutritional therapy, and in-home support are not covered.
Hearing Services See details
Hearing services covered by the Wellpoint Full Dual Advantage (HMO D-SNP) include annual routine exams and fitting evaluations with no copay and a 20% coinsurance. Hearing aids are partially covered with no copay or coinsurance up to $3,000 annually for prescription models and $300 annually for OTC models, though prescription inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP), excluding other eye exam services and eyewear upgrades. There is no deductible, and routine eye exams are covered once per year with a 20% coinsurance and no copay. Covered eyewear is subject to a $350 annual limit, featuring no copay for lenses, frames, and contacts, though contact lenses require a 20% coinsurance.
Dental Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance for preventive and comprehensive care up to a $4,000 annual limit, while Medicare-covered dental services require a 20% coinsurance and no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a coinsurance of 0% to 20%.
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 copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME requires 0% to 20% coinsurance, prosthetics and medical supplies require 20% coinsurance, and diabetic equipment has no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab tests, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. These covered services require prior authorization and a referral.
Home Health Services See details
Home Health Services are covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers some cardiac rehabilitation services with no copay, although prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellpoint Full Dual Advantage (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though additional days beyond the standard Medicare-covered limit are not covered. Prior authorization is required for these services, which do not require a prior three-day inpatient hospital stay.
Other Services See details
Other services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though highly integrated services are not covered. Covered benefits include unlimited acupuncture, meal benefits for chronic illness, Medicare Community Resource Support, and select over-the-counter items, although some CMS OTC list drugs are excluded.
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