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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 deductible of $590.00. After you meet the deductible, you pay the costs for your drugs based on the drug tier. The plan's premium may be reduced if you qualify for the low-income subsidy. If you qualify for the low-income subsidy, you will pay $18.30 for Part D. Once your total drug costs reach $2000.00, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000.00, you 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 have no copay, including primary care visits, hearing exams, and home health services. However, some services, such as outpatient services, dental, and vision services, have a 20% coinsurance. Emergency services have a copay, while other services like ambulance and transportation have coinsurance costs. This plan also includes benefits for hearing aids, dental, and vision services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. However, additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered, with a 20% coinsurance. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Dual Advantage (HMO D-SNP) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with 20% coinsurance for both ground and air ambulance services, and no copay for transportation services. Transportation services to any health-related location are covered, but not to any health-related location.
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; there is no coinsurance for any of these services.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, and 20% coinsurance for Chiropractic Services, Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, Routine Foot Care, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services, and no copay for Additional Telehealth Benefits. Physician Specialist Services, Other Health Care Professional, and Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive Services are covered, including annual physical exams with no copay. Other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs, are covered with a 20% coinsurance.
Hearing Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids with prior authorization. Routine hearing exams and fitting/evaluation for hearing aids have no copay and a coinsurance of at most 20% for routine hearing exams. Prescription hearing aids have no copay, with a maximum benefit of $1500 per year. OTC hearing aids are also covered with 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 routine eye exams with a 20% coinsurance and a $0 copay for routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses. Eyewear has a 20% coinsurance. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services are covered with a maximum benefit of $2,250 per year, and 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, 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 under the Wellpoint Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 0-20% coinsurance and requires authorization, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, and Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%. There is no copay for any of 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 generally covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or 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. You may have coinsurance costs, and prior authorization is required.
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. Over-the-counter items are covered with no copay, and the plan offers nicotine replacement therapy and Naloxone coverage. The plan also covers a meal benefit for chronic illness with no copay. Other services are covered with no copay, and a doctor's referral is required. However, 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 are not covered.
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