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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellpoint Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Wellpoint Insurance Company available for the 2026 plan year 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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:
Sign up for Wellpoint Dual Advantage (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
The Wellpoint Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Members enjoy no copay for Tier 1 Preferred Generic drugs and Tier 6 Select Care drugs. This savings applies to one-month, two-month, and three-month fills at both standard pharmacies and 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 all supply lengths. Tier 5 Specialty Tier drugs also carry a 25% coinsurance, which is applicable only to a one-month supply through standard pharmacies or standard mail order.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) plan offers comprehensive healthcare coverage with no copay for inpatient hospital stays, primary care visits, specialist consultations, and home health services. For emergency care, members pay a $115 copay, which is waived if admitted, while urgently needed services require a $40 copay and partial hospitalization has a $60 copay. Many outpatient, diagnostic, and dialysis services are covered with no copay, though they do require a 20% coinsurance. This plan also features valuable supplemental benefits, including no copay and no coinsurance for preventive and comprehensive dental care up to a $2,750 annual limit, alongside allowances for eyeglasses and hearing aids. Additionally, members can access up to 60 one-way transportation trips per year and routine acupuncture treatments with no copay or coinsurance. Durable medical equipment and diabetic supplies are also covered with no copay, though some equipment may require a coinsurance of up to 20%.
Inpatient Hospital See details
Wellpoint Dual Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay, though prior authorization is required and Medicare-defined cost-sharing applies. This benefit is partially covered because additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no copays, though a 20% coinsurance, prior authorization, and referrals apply to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible, requiring only a referral.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellpoint Dual Advantage (HMO D-SNP) plan with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Wellpoint Dual Advantage (HMO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered with no copay or coinsurance for up to 60 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $100,000 with no copay and no coinsurance.
Primary Care See details
Wellpoint Dual Advantage (HMO D-SNP) provides primary care, specialist visits, and telehealth benefits with no copay and no coinsurance. Physical, occupational, speech, mental health, psychiatric, and podiatry services are covered with no copay and a 20% coinsurance, while chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and select supplemental benefits, while glaucoma, diabetes, digital rectal, and EKG screenings require a 20% coinsurance and no copay. Sub-services such as health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers hearing services, including annual routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,500 annual limit (excluding inner ear, outer ear, and over the ear models), and OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Wellpoint Dual Advantage (HMO D-SNP), with other eye exam services and upgrades excluded from coverage. Routine eye exams and contact lenses have no copay and a 20% coinsurance, while eyeglasses, lenses, and frames have no copay and no coinsurance under a $350 annual limit.
Dental Services See details
Wellpoint Dual Advantage (HMO D-SNP) provides partially covered dental services with no copay and 20% coinsurance for Medicare-covered care, and no copay or coinsurance for preventive and comprehensive services up to a $2,750 annual limit. 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 and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellpoint Dual Advantage (HMO D-SNP) with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic supplies. DME carries a coinsurance of 0% to 20%, prosthetics and medical supplies require 20% coinsurance, and diabetic equipment features no coinsurance, with some services requiring prior authorization or specific manufacturers.
Diagnostic and Radiological Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and outpatient x-rays, with no copay and a 20% coinsurance. Prior authorization and referrals are required for all of these covered services.
Home Health Services See details
Home health services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Wellpoint Dual Advantage (HMO D-SNP) plan with no copay and prior authorization required. While some services are covered, specific sub-services—including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation—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. While the plan allows SNF admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and no coinsurance, including acupuncture, over-the-counter (OTC) items, chronic illness meals, and community resource support, while highly integrated services for dual-eligible SNPs are not covered. Acupuncture is limited to 24 treatments per year and requires prior authorization, and community resource support requires a referral.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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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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