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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 the deductible, you will pay the cost-sharing amounts for your medications based on the drug tier, until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Medicare Part D covered drugs. If you qualify for the low-income subsidy, you may have a reduced premium of $18.30.
Additional Benefits
The Wellpoint Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing options. Many services, such as primary care visits, routine eye exams, and home health services, are available with no copay. However, some services like outpatient services, ambulance services, and dental services require coinsurance, typically around 20%. This plan covers inpatient hospital stays, outpatient services, and emergency services with specific copays or coinsurance. It also includes coverage for hearing aids, vision, and dental services with no copays for some services. Additionally, the plan provides coverage for home infusion, dialysis, medical equipment, and diagnostic services, each with its own cost-sharing structure.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but additional days and non-Medicare-covered stays are not covered. For both Acute and Psychiatric inpatient hospital stays, you will pay the Medicare-defined cost share for tier 1, and you will need prior authorization.
Outpatient Services See details
Outpatient services, including all 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, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to a plan-approved health-related location with no copay. 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 by the Wellpoint Dual Advantage (HMO D-SNP) plan. Emergency Services has a $90 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers primary care physician services with no copay, chiropractic services with 20% coinsurance, occupational therapy services with 20% coinsurance, physician specialist services with no copay, mental health specialty services with 20% coinsurance for individual and group sessions, podiatry services with 20% coinsurance for routine foot care, other health care professional services with no copay, psychiatric services with 20% coinsurance for individual and group sessions, physical therapy and speech-language pathology services with 20% coinsurance, additional telehealth benefits with no copay, and opioid treatment program services with 20% coinsurance. Prior authorization and a doctor referral are required for chiropractic, occupational therapy, physician specialist, mental health specialty, podiatry, other health care professional, psychiatric, physical therapy and speech-language pathology, and opioid treatment program services.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, including glaucoma screening, diabetes self-management training, and others, are covered with a 20% coinsurance.
Hearing Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers hearing exams with a coinsurance of at most 20% for routine hearing exams and no copay for Medicare-covered benefits. Prescription hearing aids are covered with no copay and a yearly maximum of $3,000. OTC hearing aids are covered with no copay up to a maximum of $300 per year.
Vision Services See details
Vision Services include eye exams and eyewear. Routine eye exams have no copay, but a 20% coinsurance applies to other eye exams and eyewear, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Eyeglass frames and eyeglass lenses are unlimited.
Dental Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers dental services, including Medicare dental services with 20% coinsurance. Other dental services, such as oral exams, dental x-rays, and other diagnostic dental services, have no copay, and this plan has a maximum benefit of $2250 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. The plan includes a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance, Prosthetics/Medical Supplies - Non-Medicare with a 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered. 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 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 not covered by 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 prior authorization is required. This plan does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays for SNF.
Other Services See details
The Wellpoint Dual Advantage (HMO D-SNP) plan covers acupuncture with no copay, up to 24 treatments per year, and also covers Over-the-Counter (OTC) items with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, or many other services including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services.
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