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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) prescription drug plan features an annual drug deductible of $615. Beneficiaries will enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when filled through standard retail pharmacies or standard mail order services for one-, two-, or three-month supplies. For other medication categories, including Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, a 25% coinsurance applies to all supply durations. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply through standard pharmacies and standard mail order.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) offers comprehensive healthcare coverage with no copays for primary care, specialist visits, telehealth services, and inpatient hospital stays. For outpatient care, diagnostics, dialysis, and ambulance services, members generally pay no copay but are responsible for a 20% coinsurance. Emergency room visits require a $115 copay, which is waived if admitted within 24 hours, while urgently needed care carries a $40 copay. This plan also includes robust supplemental benefits, featuring preventive and comprehensive dental care up to $2,250 annually and routine eye exams with no copays. Hearing aids are covered with no copay or coinsurance up to $1,500 annually for prescription models, and members can utilize up to 48 free one-way transportation trips to approved medical locations per year. Additionally, diabetic supplies, home health services, and over-the-counter items are fully covered with no copays or coinsurance.
Inpatient Hospital See details
Wellpoint Dual Advantage (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. This benefit does not cover additional hospital days, non-Medicare-covered stays, or room upgrades.
Outpatient Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are fully covered with no copay and no coinsurance.
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 to access this benefit.
Ambulance and Transportation Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered, offering no copay or coinsurance for up to 48 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copays or coinsurance up to a $100,000 maximum benefit limit.
Primary Care See details
Wellpoint Dual Advantage (HMO D-SNP) covers primary care, specialist, and telehealth services with no copay and no coinsurance, while mental health, psychiatric, therapy, and opioid treatment services require no copay and a 20% coinsurance. Some chiropractic services are covered, but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellpoint Dual Advantage (HMO D-SNP), offering an annual physical, kidney education, and select supplemental benefits with no copay and no coinsurance, while glaucoma screenings, diabetes training, digital rectal exams, and EKGs require a 20% coinsurance and no copay. Sub-services not covered under this plan include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services covered by Wellpoint Dual Advantage (HMO D-SNP) feature no deductible, no copays for fitting evaluations, and a 20% coinsurance with no copay for routine annual exams. Prescription hearing aids are partially covered with up to $1,500 annually and no coinsurance, excluding inner ear, outer ear, and over the ear models, while OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers vision services with no deductibles, including one routine eye exam per year with no copay and a 20% coinsurance, though other eye exams are not covered. Eyewear is covered up to a $275 annual limit with no copay (plus a 20% coinsurance for contact lenses), but upgrades are not covered.
Dental Services See details
Wellpoint Dual Advantage (HMO D-SNP) offers partially covered dental services with no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services up to a $2,250 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% 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
Wellpoint Dual Advantage (HMO D-SNP) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, subject to prior authorization. Prosthetics and medical supplies are also covered with no copay and 20% coinsurance under prior authorization, while diabetic supplies and therapeutic shoes are fully covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no copays, but they are subject to a 20% coinsurance for diagnostic procedures, lab services, radiological services, and outpatient X-rays. Prior authorization and referrals are required for all of these covered diagnostic and radiological services.
Home Health Services See details
Home health services are covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and require prior authorization. Although some services are covered, specific options such as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Wellpoint Dual Advantage (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. The plan allows for admission with less than a three-day prior inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellpoint Dual Advantage (HMO D-SNP) covers other services with no copay and no coinsurance, including up to 24 acupuncture treatments per year, over-the-counter items, chronic illness meal benefits, and Medicare Community Resource Support. Highly integrated services for dual-eligible SNPs are not covered under this benefit.
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