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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 the deductible, you will pay costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your Part D premium will be $18.30. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) plan offers a wide range of benefits with varying costs. Many services, such as primary care, hearing exams, and vision exams, have no copay. The plan also includes coverage for inpatient and outpatient services, emergency services, and home health services, with some services subject to coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Note that additional days for Inpatient Hospital-Acute/Psychiatric, and non-Medicare-covered stays for Inpatient Hospital-Acute/Psychiatric are not covered, and upgrades for Inpatient Hospital-Acute are also not covered.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services and Observation Services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Dual Advantage (HMO D-SNP) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services with a 20% coinsurance, and transportation services with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $90 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers primary care physician services with no copay. Chiropractic services have a 20% coinsurance, while occupational therapy services and physical therapy/speech-language pathology services have a 20% coinsurance. Physician specialist services and additional telehealth benefits have no copay, while mental health specialty services, psychiatric services, and opioid treatment program services have a 20% coinsurance. Podiatry services have a 20% coinsurance for routine foot care and no copay for Medicare-covered podiatry services. Other health care professional services have no copay.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Other preventive services may have a copay, and glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and over-the-counter (OTC) hearing aids. Routine hearing exams have no copay and a maximum of 20% coinsurance, and fitting/evaluation for hearing aids have no copay and no coinsurance. Prescription hearing aids have no copay and are limited to $3,000 per year. OTC hearing aids have no copay, with a maximum benefit of $300 per year.
Vision Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers vision services including eye exams and eyewear. Routine eye exams have no copay and 20% coinsurance, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Eyewear has a combined maximum plan benefit coverage of $300 per year, and upgrades are not covered.
Dental Services See details
Dental services are covered under the Wellpoint Dual Advantage (HMO D-SNP) plan. Medicare dental services have a 20% coinsurance and require prior authorization, while other dental services have a maximum benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, 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 by 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 (DME) with 0-20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay; Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellpoint Dual Advantage (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%. There is no copay for these services.
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 covered, but the plan does not cover any of the sub-services, including 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. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, and prior authorization is required. The plan does not cover additional days beyond Medicare-covered for SNF, nor does it cover non-Medicare-covered stays for SNF.
Other Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers acupuncture with no copay, up to 24 treatments per year, and requires prior authorization. The plan also covers over-the-counter items with no copay, and offers a meal benefit with no copay for a chronic illness. Medicare Community Resource Support is covered with no copay and requires a doctor referral. Many other services under the "Other Services" benefit are not covered.
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