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Wellcare Dual Access (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Access (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in ME. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Dual Access (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Dual Access (HMO-POS 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 Wellcare Dual Access (HMO-POS 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 Wellcare Dual Access (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.10. 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 $530.00 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 Wellcare Dual Access (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $530. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply, with no copay required for a three-month supply via preferred mail order. Additionally, Tier 6 select care drugs offer maximum savings with no copay across all supply options and pharmacies. Tier 3 preferred brand drugs require a flat 20% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply. Tier 4 non-preferred drugs have copays starting at $100 for a one-month supply at both standard and preferred pharmacies. These structured cost-sharing tiers help you easily estimate your monthly prescription medication expenses.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan covers inpatient hospital stays with a $1,975 copay per admission, while offering no copay for primary care, specialist visits, and outpatient services. Although there is no copay for most outpatient care, diagnostic tests, and medical equipment, a standard 20% coinsurance usually applies. Emergency room visits require a $115 copay and urgent care services have a $40 copay, both featuring no coinsurance. Additionally, the plan provides valuable routine dental, vision, and hearing benefits to help lower your out-of-pocket costs. Preventive and comprehensive dental services are covered up to $1,500 annually with no copay or coinsurance, and hearing aids are covered up to $500 per ear each year with no copay. Members also enjoy no copay and no coinsurance for home health services, over-the-counter items, and chronic illness meal benefits.
Inpatient Hospital See details
Wellcare Dual Access (HMO-POS D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,975 copayment per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers outpatient services with no copayments, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Dual Access (HMO-POS D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. For transportation services, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers emergency services with a $115 copay and urgent care with a $40 copay, both featuring no coinsurance and cost-sharing that applies to the plan deductible. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access (HMO-POS D-SNP) covers primary care, specialist, mental health, physical therapy, and opioid treatment services with no copay and a 20% coinsurance, while chiropractic and podiatry services are not covered. Additional telehealth benefits are also available with a 20% coinsurance and copays ranging from $0 to $40.
Preventive Services See details
Preventive services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), featuring no copay and no coinsurance for annual physical exams, alternative therapies, memory fitness, and remote access technologies. Kidney disease education and other preventive screenings—including glaucoma, diabetes self-management, digital rectal exams, and post-welcome visit EKGs—are covered with no copay and a 20% coinsurance. Excluded sub-services include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Wellcare Dual Access (HMO-POS D-SNP) with no deductible, offering Medicare-covered exams and fitting evaluations with no copay, and annual routine exams with a 20% coinsurance and no copay. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Dual Access (HMO-POS D-SNP), offering one routine eye exam per year with no copay and a 20% coinsurance, while other eye exams are not covered. Eyewear is covered with no copay up to a $100 annual limit, though contact lenses require a 20% coinsurance and prior authorization is required for vision services.
Dental Services See details
Wellcare Dual Access (HMO-POS D-SNP) offers partially covered dental services with prior authorization required, featuring no copay and 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $1,500 yearly limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers Home Infusion bundled Services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Dual Access (HMO-POS D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access (HMO-POS D-SNP) covers medical equipment—including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services—with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access (HMO-POS D-SNP) covers diagnostic and radiological services with no copay, though a minimum 20% coinsurance and prior authorization are required. Covered benefits include diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Wellcare Dual Access (HMO-POS D-SNP) with no copay, but some services are not covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access (HMO-POS D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and days 71 to 100, but a $218 daily copay applies for days 21 to 70, and prior authorization is required.
Other Services See details
Wellcare Dual Access (HMO-POS D-SNP) partially covers other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other miscellaneous services under this benefit are not covered.
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