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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 costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, your monthly Part D premium is $18.30. Once 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 range of benefits with varying cost-sharing options. Many services, like primary care visits, routine hearing exams, prescription hearing aids, and many dental services, have no copay. This plan includes coverage for inpatient and outpatient services, with coinsurance applicable to some services like outpatient hospital services and ambulance services. This plan also covers a variety of other services, including hearing, vision, and dental care, with specific cost-sharing details outlined for each. Emergency services have a copay, while preventive services are covered, with some services requiring a copay and others having a coinsurance. Additionally, the plan provides coverage for home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Wellpoint Dual Advantage (HMO D-SNP) plan, but additional days and non-Medicare-covered stays are not covered. The plan uses the Medicare-defined cost share for tier 1, and coinsurance information is available.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered under this plan. Outpatient hospital and observation services have a 20% coinsurance, while 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. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Dual Advantage (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay, with coverage for up to 60 one-way trips per year, and 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 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 services with this plan include no copay. Chiropractic Services are covered with a 20% coinsurance. Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services are covered, and some services require a copay, but other services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit have a 20% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams, with no copay and a minimum coinsurance of 20%, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay, up to $300 every year.
Vision Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers vision services, including routine eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services, and other dental services have a maximum plan benefit of $2,750 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. DME has a 0-20% coinsurance, and requires prior authorization. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
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 no copay and a coinsurance of at most 20%, while diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have no copay and 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 not covered under the Wellpoint Dual Advantage (HMO D-SNP) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. This plan requires prior authorization and charges the Medicare-defined cost share for tier 1, with coinsurance details available in the plan information.
Other Services See details
Under "Other Services," Wellpoint Dual Advantage (HMO D-SNP) covers acupuncture with no copay, and a limit of 24 treatments per year, as well as over-the-counter items, a meal benefit, and "Other 1" services with no copay, but some of the services are not covered. 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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