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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 $590.00 deductible for prescription drugs. Once the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $13.90. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying cost-sharing. Many services have no copay, such as routine eye exams, hearing exams, and various dental services. However, some services require a copay or coinsurance, such as emergency services, specialist visits, and certain diagnostic tests. Additional benefits include coverage for hearing aids, vision services, dental services, and home health services. The plan also provides coverage for medical equipment, ambulance and transportation services, and other services like acupuncture and over-the-counter items. Overall, the plan aims to provide comprehensive coverage with a focus on managing costs through copays, coinsurance, and prior authorization requirements for certain services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. The plan does not specify cost-sharing details, but notes that the Medicare-defined cost share for tier 1 is charged. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a 20% coinsurance. Ambulatory Surgical Center and Outpatient Substance Abuse Services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. 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
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay for up to 60 one-way trips per year.
Emergency Services See details
Emergency Services, including 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, Urgently Needed Services have a $45 copay, and 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 services with a 20% coinsurance. Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services are covered with a 20% coinsurance. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Additional Telehealth Benefits are covered with no copay. Podiatry Services are covered with a 20% coinsurance, and Medicare-covered Podiatry Services have no copay.
Preventive Services See details
Preventive services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan. You will have no copay for an annual physical exam, and for other preventive services, you will need to refer to the plan for copay information. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have a 20% coinsurance.
Hearing Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay and at most 20% coinsurance for hearing exams, as well as prescription hearing aids with no copay and OTC hearing aids with no copay. Prescription hearing aids have a maximum plan benefit coverage of $3,000 per year, and OTC hearing aids have 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 coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams have no copay. Eyewear has a 20% coinsurance and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, but upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a 20% coinsurance, and Other Dental Services with a maximum benefit of $5,000 per year. Oral exams, Dental X-rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable & fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics all have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. The plan also covers Prosthetic Devices and Medical Supplies, both with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered with no copay, but may have a coinsurance of up to 20%. Prior authorization and a doctor referral are required.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan 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 by the Wellpoint Full Dual Advantage (HMO D-SNP), but require prior authorization. There is no copay, and coinsurance information is available in the plan details. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
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. Other services include Medicare Community Resource Support with no copay, but a doctor referral is required. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services.
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