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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. If you qualify for the low-income subsidy, your monthly premium for Part D is $13.90. During the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Wellpoint Full Dual Advantage (HMO D-SNP) plan offers comprehensive coverage with a focus on outpatient care, preventative services, and specialized treatments. Many services have no copay, including routine eye exams, home health services, and over-the-counter items. However, some services may require coinsurance, such as outpatient services, vision services, and dental services. This plan includes coverage for a wide range of services like hearing, vision, and dental. It also covers emergency services, transportation, and home infusion services. Note that some services, such as inpatient hospital stays, have coinsurance requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but 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. For covered services, you will pay the Medicare-defined coinsurance.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers ambulance and transportation services. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay and are limited to 60 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Full Dual Advantage (HMO D-SNP) plan. Emergency Services has a $90 copay, and Urgently Needed Services has a $45 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
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, physical therapy and speech-language pathology services have a 20% coinsurance, while occupational therapy services, mental health specialty services, psychiatric services, and opioid treatment program services have a minimum of 20% and a maximum of 20% coinsurance. Additional telehealth benefits have no copay. Podiatry services have a 20% coinsurance for routine foot care and no copay for Medicare-covered podiatry services. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services, including an annual physical exam, are covered with no copay. Additional preventive services, such as glaucoma screenings and diabetes self-management training, are covered with a 20% coinsurance.
Hearing Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers hearing exams, routine hearing exams (1 per year with no copay and 20% coinsurance), and fitting/evaluation for hearing aids (1 per year with no copay). Prescription hearing aids are covered with a $3,000 maximum benefit per year and no copay, but inner, outer, and over-the-ear hearing aids are not covered. OTC hearing aids are covered with no copay, and a $300 maximum benefit per year.
Vision Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams have no copay. Eyewear has a 20% coinsurance, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. 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 and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan, including insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Insulin has 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. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
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 any of these services, but you may have to pay up to 20% coinsurance. A doctor referral and prior authorization are required.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellpoint Full Dual Advantage (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered stays, or non-Medicare-covered stays. There is coinsurance for SNF services.
Other Services See details
The Wellpoint Full Dual Advantage (HMO D-SNP) plan covers acupuncture, over-the-counter (OTC) items, and a meal benefit with no copay. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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