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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 drug deductible of $615. Under this plan, members enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs filled through standard pharmacies or standard mail order. This zero-dollar cost-sharing applies to one-month, two-month, and three-month supplies, helping you save on essential everyday medications. For higher-tier medications, including Tier 3 preferred brand and Tier 4 non-preferred drugs, members pay a 25% coinsurance for standard pharmacy and mail-order fills. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply. These structured costs help you budget effectively for both generic and brand-name prescription drug needs under your Medicare plan.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) offers comprehensive medical coverage designed to keep out-of-pocket costs low by featuring no copays on many essential services. Members pay no copay or coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient care, diagnostics, and primary or specialist visits, the plan typically charges no copay alongside a twenty percent coinsurance. Supplemental benefits are a major highlight, offering preventive and comprehensive dental care with no copay or coinsurance. Vision and hearing benefits include routine exams with no copay and substantial annual allowances for eyeglasses and hearing aids. Members also enjoy added perks like a fitness program, personal emergency response systems, and up to forty-eight free one-way transportation trips per year.
Inpatient Hospital See details
Wellpoint Full Dual Advantage (HMO D-SNP) offers partially covered inpatient hospital services with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay, though a 20% coinsurance applies to outpatient hospital, observation, 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 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellpoint Full Dual Advantage (HMO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services have no copay or coinsurance up to a $100,000 maximum benefit limit.
Primary Care See details
Primary Care benefits under the Wellpoint Full Dual Advantage (HMO D-SNP) are covered with no copay and 20% coinsurance for most services, including primary care provider, specialist, therapy, mental health, and psychiatric visits. Additional telehealth benefits are covered with no copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services under the Wellpoint Full Dual Advantage (HMO D-SNP) are partially covered, offering an annual physical exam, kidney disease education, and select supplemental benefits like a fitness program and PERS with no copay and no coinsurance. Other preventive services, including glaucoma screenings, diabetes training, digital rectal exams, and EKGs, require a referral and carry a 20% coinsurance with no copay, while services like health education and nutritional therapy are not covered.
Hearing Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers hearing services with no deductible, including 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 or coinsurance up to a $3,000 annual limit (inner, outer, and over-the-ear types are not covered), while over-the-counter hearing aids are covered up to $300 per year with no copay or coinsurance.
Vision Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) provides partially covered vision services with no deductible, including one annual routine eye exam and contact lenses for no copay and 20% coinsurance. Eyeglasses, lenses, and frames are covered with no copay and no coinsurance up to a $700 annual limit, though other eye exams and upgrades are not covered.
Dental Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) provides partially covered dental services, featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive dental care. However, maxillofacial prosthetics, implant services, and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Covered Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
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
Medical equipment is covered under the Wellpoint Full Dual Advantage (HMO D-SNP) with no copays for all services. Durable medical equipment requires 0% to 20% coinsurance, prosthetics and medical supplies carry a 20% coinsurance, and diabetic equipment is covered with no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services with no copay, though a 20% coinsurance applies to all lab services, diagnostic procedures, X-rays, and radiological treatments. Prior authorization and referrals are required for all of these covered services.
Home Health Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers home health services 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 Cardiac Rehabilitation Services with no copay and prior authorization, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellpoint Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond Medicare-covered limits are not covered.
Other Services See details
Wellpoint Full Dual Advantage (HMO D-SNP) covers acupuncture, chronic illness meal benefits, Medicare Community Resource Support, and select over-the-counter items with no copay and no coinsurance. Highly integrated dual eligible SNP services and certain drugs on the CMS over-the-counter list are not covered.
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