Wellpoint Dual Advantage (HMO D-SNP)

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.

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.

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:

Drug Coverage

The Wellpoint Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order for one-, two-, or three-month supplies. This cost-effective structure helps members save money on essential daily medications. For other tiers, including Tier 2 generics, Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, members are responsible for a 25% coinsurance. This 25% coinsurance rate applies to standard retail pharmacy and standard mail-order purchases, with specialty tier coverage limited to a one-month supply. Understanding these copay and coinsurance rates helps you accurately budget your healthcare costs.

Additional Benefits

The Wellpoint Dual Advantage (HMO D-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, primary care, specialist visits, and home health services. For emergency care, members pay a 115 dollar copay with no coinsurance, which is waived if admitted, while urgent care visits require a 40 dollar copay. Most outpatient hospital services, diagnostic tests, and dialysis services require no copay but are subject to a 20 percent coinsurance. This plan also features robust supplemental benefits, including preventive and comprehensive dental care, routine eye exams, and home infusion services with no copay and no coinsurance, though some vision services may require a 20 percent coinsurance. Additionally, members benefit from no copay or coinsurance for up to 60 one-way transportation trips annually, prescription hearing aids up to a 3,000 dollar yearly limit, and select over-the-counter items. Durable medical equipment is covered with no copay and a coinsurance ranging from 0 to 20 percent.