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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. After you meet your deductible, you will pay the costs for your drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, and the monthly premium for Part D is $13.90. After your total drug costs reach $2000, you enter the catastrophic coverage phase. In this phase, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services have no copay, including preventive services like annual physical exams, routine eye exams, and some dental and hearing services. Other services, such as outpatient care, primary care, and vision services, typically involve a 20% coinsurance. This plan provides coverage for inpatient and outpatient hospital services, along with emergency and transportation services, subject to copays or coinsurance. Additional benefits include hearing aids, eyewear, dental, and home health services, with specific cost-sharing details for each.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan; however, additional days, non-Medicare covered stays, and upgrades for acute and psychiatric care are not covered. The coinsurance for inpatient hospital services is determined by the Medicare-defined cost share.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered with a 20% coinsurance. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, up to 60 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. 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 all 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 services, 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, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services have a 20% coinsurance, while Additional Telehealth Benefits have no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other preventive services with a copay. Glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams with no copay and 20% coinsurance for routine hearing exams, fitting/evaluation for hearing aids with no copay, prescription hearing aids with no copay and a maximum benefit of $3,000 per year, and OTC hearing aids with no copay and 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
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear has a 20% coinsurance, and a combined maximum plan benefit coverage of $500.00 per year for eyeglasses, with contact lenses, eyeglass lenses, and eyeglass frames having no copay. Upgrades are not covered.
Dental Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers dental services, including Medicare Dental Services with 20% coinsurance, and other dental services with a $5,500 maximum benefit per year. Preventive services like oral exams, x-rays, cleanings, fluoride treatments and other preventive dental services have no copay, while restorative services, orthodontics, and other services require prior authorization and have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of up to 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance; Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay for these services, but you may have to pay coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires prior authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan. Although the plan covers Cardiac Rehabilitation Services, it 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, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and the coinsurance is defined by Medicare.
Other Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers acupuncture, over-the-counter items, meal benefits, and other services. Acupuncture and over-the-counter items have no copay, and the meal benefit has no copay. Some services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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