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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) plan features an annual prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using standard pharmacies or standard mail order services. This zero-cost coverage applies to one-month, two-month, and three-month supplies of these medications. For other prescription tiers, including Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, the plan requires a 25% coinsurance. This 25% coinsurance applies to both standard pharmacy and standard mail order fills for all covered supply lengths. Knowing these predictable costs helps you easily budget for your monthly medication needs under this plan.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers comprehensive medical coverage with no copays for inpatient hospital stays, skilled nursing facility care, and home health services. While many primary care, outpatient, and diagnostic services also feature no copays, they generally require a standard 20% coinsurance. For urgent and emergency needs, members will pay a $40 copay for urgent care and a $115 copay for emergency room visits, which is waived upon hospital admission. This plan also includes valuable extra benefits such as dental, vision, and hearing coverage, featuring no deductibles and no copays alongside varying coinsurance options. Additionally, members can access up to 48 routine transportation trips, acupuncture, and over-the-counter items with no copays and no coinsurance. These combined benefits are designed to minimize your out-of-pocket expenses while ensuring access to essential daily health resources.
Inpatient Hospital See details
Wellpoint Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric stays with no copay and no coinsurance, subject to prior authorization. However, additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers outpatient services with no copay, featuring a 20% coinsurance for outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible, though referrals and prior authorizations are required for most outpatient care.
Partial Hospitalization See details
Partial hospitalization is covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
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, while transportation services are partially covered with no copay and no coinsurance. Under this benefit, up to 48 one-way trips per year to plan-approved health-related locations are covered, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services under the Wellpoint Full Dual Advantage (HMO D-SNP) are covered 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 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, therapy, mental health, and podiatry services with no copay and 20% coinsurance, though chiropractic services are not covered in practice. Additional telehealth benefits are also available for select services with no copay and no coinsurance.
Preventive Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers preventive services with no copay and no coinsurance for annual physicals and kidney education, but requires no copay and a 20% coinsurance (plus a referral) for glaucoma screenings, diabetes training, digital rectal exams, and EKGs. Additional preventive benefits are partially covered, offering fitness, remote access, PERS, and home safety devices with no copay and no coinsurance, while health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers hearing services with no deductible, offering routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $3,000 annual limit—excluding inner ear, outer ear, and over the ear models—while OTC hearing aids are covered with no copay and no coinsurance up to $300 annually.
Vision Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) vision services are partially covered with no deductibles, though upgrades and other eye exam services are excluded. One routine eye exam per year and contact lenses have no copay and 20% coinsurance, while covered eyeglasses and lenses have no copay and no coinsurance up to a $250 annual maximum.
Dental Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) dental services are partially covered, featuring no copay and a 20% coinsurance for Medicare-covered dental, alongside other covered preventive and comprehensive services with no copay, no coinsurance, and a $3,000 yearly maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan, and certain services require prior authorization.
Home Infusion bundled Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry no copay and a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by 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. Coinsurance ranges from no coinsurance to 20% for DME, is 20% for prosthetics and medical supplies, and is 0% (no coinsurance) for diabetic supplies and therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay, but a 20% coinsurance applies to all Medicare-covered tests, lab services, X-rays, and radiological treatments. Prior authorization and referrals are required for these covered diagnostic and radiological services.
Home Health Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan with no copay and prior authorization required; however, while some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Admission is allowed without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellpoint Full Dual Advantage (HMO D-SNP), featuring no copay and no coinsurance for unlimited acupuncture, chronic illness meal benefits, Medicare community resource support, and over-the-counter (OTC) items. Highly integrated dual eligible SNP services are not covered, and the OTC benefit does not cover all drugs on the CMS OTC list.
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