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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 features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled at standard pharmacies or through standard mail order for up to a three-month supply. For Tier 3 preferred brand and Tier 4 non-preferred drugs, members are responsible for a 25% coinsurance for one-, two-, or three-month supplies. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply through standard pharmacies or standard mail order.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) offers robust medical coverage with no copays for inpatient hospital stays, skilled nursing facility care, and home health services. While primary care and outpatient services feature no copays, a 20% coinsurance applies to specialist visits, outpatient hospital care, and diagnostic services. Emergency room visits require a $115 copay, which is waived upon admission, while urgent care services have a $40 copay. This plan also includes comprehensive supplemental benefits, such as preventive and comprehensive dental care with no copay and no coinsurance up to a generous $5,000 annual limit. Members can access routine vision and hearing care with no copays, alongside allowances for eyewear and hearing aids, plus up to 60 one-way transportation trips per year at no cost. Additional perks like over-the-counter items, fitness programs, and acupuncture are also covered with no copays or coinsurance.
Inpatient Hospital See details
Wellpoint Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric hospital stays with no copay and no coinsurance, subject to prior authorization. Under this plan, additional days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers outpatient services with no copays, although a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $60.00 copayment and no coinsurance. Prior authorization is required to access these covered services.
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 for up to 60 one-way trips per year to plan-approved health-related 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, which is waived if 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 a $100,000 limit with no copay and no coinsurance.
Primary Care See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers primary care, specialist, psychiatric, and physical therapy services with no copay and 20% coinsurance, though chiropractic services are not covered. Additional telehealth benefits are also covered with no copay and no coinsurance.
Preventive Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) provides partially covered preventive services, offering annual physical exams, kidney disease education, and select supplemental benefits like fitness and personal emergency response systems with no copay and no coinsurance. However, sub-services such as 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/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, and counseling are not covered. Other preventive services, including glaucoma screenings and diabetes self-management training, are covered with no copay and a 20% coinsurance, requiring a referral.
Hearing Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers hearing services, offering routine exams and fitting evaluations with no copay and a 20% coinsurance for routine exams. Prescription hearing aids are partially covered with no copay or coinsurance up to a $3,000 annual limit, though inner ear, outer ear, and over the ear types are not covered, while over-the-counter hearing aids are covered with no copay or coinsurance up to $300 annually.
Vision Services See details
Vision services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no deductibles and a $500 annual limit on eyewear. Routine eye exams and contact lenses are available with no copay and 20% coinsurance, while eyeglasses have no copay or coinsurance; however, other eye exams and upgrades are not covered.
Dental Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) offers partially covered dental services, excluding implant services, orthodontics, and maxillofacial prosthetics. Medicare-covered dental services require no copay with a 20% coinsurance, while other preventive and comprehensive dental services are available with no copay and no coinsurance up to a $5,000 annual limit.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copays across all benefits, though coinsurance rates vary. Durable medical equipment requires 0% to 20% coinsurance, prosthetic devices and medical supplies have a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services—including lab services, diagnostic tests, therapeutic radiology, and outpatient X-rays—with no copay and a 20% coinsurance. Prior authorization and referrals are required for all of these covered services.
Home Health Services See details
Home health services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) does not cover cardiac rehabilitation services in practice, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are all not covered, requiring a 20% coinsurance and no copay.
Skilled Nursing Facility (SNF) See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) provides partial coverage for other services with no copay and no coinsurance, including acupuncture, meal benefits, and Medicare community resource support. Over-the-counter items are also covered with no copay and no coinsurance, though highly integrated services for dual eligible SNPs and certain CMS OTC list drugs are not covered.
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