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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) Medicare plan features an annual prescription drug deductible of $615. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order services. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, the plan requires a 25% coinsurance for 1-month, 2-month, and 3-month supplies. Tier 5 specialty drugs also carry a 25% coinsurance for a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) offers comprehensive healthcare coverage with no copay and no coinsurance for inpatient hospital stays, primary care visits, specialist appointments, and home health services. Outpatient hospital services, diagnostic tests, and dialysis generally feature no copays but carry a 20% coinsurance. For urgent and emergency needs, members pay a $40 copay for urgent care and a $115 copay for emergency room visits, with no coinsurance required. This plan also includes valuable supplemental benefits, such as dental care with no copay or coinsurance up to a $3,500 annual limit, and eyewear with no copay up to a $250 annual allowance. Additionally, members receive up to $3,000 annually for prescription hearing aids with no copay or coinsurance, alongside 38 one-way transportation trips to approved health locations with no copay. Diabetic supplies and therapeutic shoes are also fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, although prior authorization is required. This benefit does not cover additional hospital days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers outpatient services with no copays, although 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
Partial hospitalization services are covered by Wellpoint Dual Advantage (HMO D-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Additionally, the plan covers up to 38 one-way transportation trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance up to a $100,000 maximum lifetime benefit.
Primary Care See details
Wellpoint Dual Advantage (HMO D-SNP) provides primary care, specialist visits, and telehealth services with no copays and no coinsurance. Physical, occupational, speech, mental health, and podiatry services are also covered with no copays and a 20% coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers preventive services, including annual physical exams and kidney disease education with no copay and no coinsurance. Some additional preventive benefits like fitness programs and home safety modifications are covered with no copay or coinsurance, though services like health education, nutritional therapy, and in-home support are not covered. Other services, such as glaucoma screenings and diabetes self-management training, require a referral and have no copay but carry a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Wellpoint Dual Advantage (HMO D-SNP), which features routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids up to $3,000 and OTC hearing aids up to $300 are covered annually with no copays or coinsurance, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellpoint Dual Advantage (HMO D-SNP), featuring one routine eye exam per year and eyewear with no copays, though a 20% coinsurance applies to routine exams and contact lenses. There is no deductible and a $250 annual limit for eyewear, but other eye exams and eyewear upgrades are not covered.
Dental Services See details
Wellpoint Dual Advantage (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a $3,500 annual maximum, though Medicare-covered dental services require a 20% coinsurance and no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy and other Part B drugs are covered with no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellpoint Dual Advantage (HMO D-SNP), offering durable medical equipment with no copay and 0% to 20% coinsurance. Prosthetics and medical supplies are covered with no copay and 20% coinsurance, while diabetic supplies and therapeutic shoes are provided with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab tests, X-rays, and therapeutic radiology, with no copay and a 20% coinsurance. Prior authorization and referrals are required for these covered services.
Home Health Services See details
Home health services are fully covered under the Wellpoint Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Wellpoint Dual Advantage (HMO D-SNP) plan. This includes standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation, which are all uncovered and subject to a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellpoint Dual Advantage (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While standard Medicare-covered days are covered without requiring a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellpoint Dual Advantage (HMO D-SNP) offers partially covered other services with no copay and no coinsurance, which includes up to 24 acupuncture treatments per year, over-the-counter items, chronic illness meals, and Medicare Community Resource Support. Highly integrated services for dual-eligible SNPs and other miscellaneous services are not covered under this benefit.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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