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Wellpoint Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint 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 Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellpoint 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 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 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 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 Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled through standard pharmacies or standard mail order. This cost savings applies to one-month, two-month, and three-month supplies of these medications. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for all supply lengths at standard pharmacies and mail order services. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply. This structure helps you easily estimate your out-of-pocket costs for various drug tiers.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) plan offers comprehensive coverage designed to minimize out-of-pocket costs, featuring no copay and no coinsurance for inpatient hospital stays, primary care and specialist visits, and home health services. Members also benefit from no copay and no coinsurance on routine dental care up to a $3,000 annual limit, skilled nursing facility care, and up to 48 one-way transportation trips to plan-approved locations. Additionally, essential preventive care, annual physical exams, and select fitness benefits are covered with no copay and no coinsurance. For other healthcare needs, several services require no copay but are subject to a 20% coinsurance, including outpatient hospital services, routine vision exams, dialysis, and diagnostic radiological tests. Emergency room visits carry a $115 copay, which is waived if admitted within 24 hours, while urgently needed care requires a $40 copay. Durable medical equipment and prescription hearing aids are also covered, with hearing aids offering up to $3,000 in annual coverage with no copay or coinsurance.
Inpatient Hospital See details
Wellpoint Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, providing acute and psychiatric hospital stays with no copay and no coinsurance, subject to prior authorization. However, additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no copays, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellpoint Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, providing up to 48 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Wellpoint Dual Advantage (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Wellpoint Dual Advantage (HMO D-SNP) provides primary care, specialist, and telehealth visits with no copay and no coinsurance. Mental health, physical, occupational, speech, and opioid treatment therapies are covered with no copay and a 20% coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers annual physical exams, kidney disease education, and select supplemental benefits like fitness and personal emergency response systems with no copay and no coinsurance. Other preventive services, such as glaucoma screenings and diabetes self-management training, require a referral and have a 20% coinsurance with no copay, while several additional health and wellness services are not covered.
Hearing Services See details
Wellpoint 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 or coinsurance. Hearing aids are partially covered with no copay or coinsurance, offering up to $3,000 annually for prescription hearing aids and up to $300 annually for OTC hearing aids, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Wellpoint Dual Advantage (HMO D-SNP), excluding eyewear upgrades and other non-routine eye exams. Covered routine eye exams and contact lenses have no copay and 20% coinsurance, while eyeglasses have no copay and no coinsurance, up to a $125 annual limit with no deductibles.
Dental Services See details
Wellpoint Dual Advantage (HMO D-SNP) offers partially covered dental services with no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $3,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay, while associated Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance. Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellpoint Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellpoint Dual Advantage (HMO D-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics or medical supplies with no copay and 20% coinsurance. Diabetic equipment and supplies are also covered with no copays and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, though prior authorization and referrals are required. This coverage includes outpatient diagnostic procedures, lab services, therapeutic and diagnostic radiology, and outpatient X-rays.
Home Health Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and require prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required and additional days beyond Medicare-covered days are not covered. Admission to a SNF is allowed under this plan without requiring a prior three-day inpatient hospital stay.
Other Services See details
Other services under the Wellpoint Dual Advantage (HMO D-SNP) are covered with no copay and no coinsurance, including acupuncture up to 24 treatments per year, over-the-counter items, chronic illness meals, and community resource support. Highly integrated services for dual eligible SNPs and select other services are not covered.
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