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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 2025, 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 2025.
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 $18.30. 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 Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the cost sharing for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your monthly premium is $18.30.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing options. Many services have no copay, including primary care visits, hearing exams, and preventive services like annual physicals. However, some services, such as outpatient services and dental care, may have a coinsurance of up to 20%, while emergency services have a $90 copay. The plan also provides coverage for specific services like hearing aids, vision care, and transportation to health-related locations. Hearing aids have a maximum benefit of $3,000 per year for prescription hearing aids and $300 per year for OTC hearing aids. Vision services include coverage for eye exams and eyewear, with a combined maximum benefit of $200 for eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days and non-Medicare-covered stays are not covered. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay the Medicare-defined cost share for tier 1, and prior authorization is required.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services and observation services with 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a coinsurance between 20% and 20%, and outpatient substance abuse services with a coinsurance between 20% and 20%. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Dual Advantage (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay, and are limited to 60 one-way trips per year. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. 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
Primary Care benefits include no copay for Primary Care Physician Services, while Chiropractic Services have a 20% coinsurance. Occupational Therapy Services and Physical Therapy Services each have a 20% coinsurance, but no copay. Physician Specialist Services, Additional Telehealth Benefits, and Other Health Care Professional Services have no copay, while Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Podiatry Services have no copay for Medicare-covered services and a 20% coinsurance for Routine Foot Care.
Preventive Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers preventive services, including annual physical exams with no copay, and additional services such as Personal Emergency Response System (PERS) and Fitness Benefit with no copay. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and a 20% coinsurance, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have no copay, with a maximum benefit of $3,000 per year. OTC hearing aids have no copay, with a maximum benefit of $300 per year.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Routine eye exams have no copay and a 20% coinsurance, while eyewear has a 20% coinsurance with a $200 combined maximum plan benefit for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers dental services, including oral exams, dental x-rays, and cleanings with no copay; however, there is a 20% coinsurance for Medicare Dental Services. Other dental services have a maximum plan benefit coverage of $3000 every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellpoint Dual Advantage (HMO D-SNP) plan, but require prior authorization. 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 Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include durable medical equipment with 0-20% coinsurance and no copay, prosthetics and medical supplies with 20% coinsurance and no copay, and diabetic equipment. Diabetic supplies and therapeutic shoes/inserts have no copay, while durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellpoint Dual Advantage (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic, Therapeutic, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellpoint 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 generally covered, but the plan specifies that none of the sub-services are covered. There is a coinsurance for some services, but the specific amount is not provided. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required. This plan follows Original Medicare for SNF services and does not provide additional days beyond Medicare coverage or non-Medicare-covered stays.
Other Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 24 treatments per year. Over-the-counter items and meal benefits are covered with no copay, and Medicare Community Resource Support is covered with no copay and a doctor referral is required. 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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