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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 2025, 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 All counties in ME. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $33.80. 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 $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 Wellcare Dual Access (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $33.80. After the deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. Once you reach $2000 in out-of-pocket drug costs, you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers coverage for a wide range of services. Inpatient hospital stays have a high copay, while outpatient services often involve coinsurance. Emergency services and hearing exams have copays, and prescription hearing aids have a set yearly cost. Vision and dental services are covered with copays and coinsurance, and eyewear has a yearly maximum benefit. Many preventive services, like annual checkups, have no copay. The plan also includes coverage for home health services and skilled nursing facilities, with varying costs. Other benefits include coverage for medical equipment, diagnostic services, and home infusion bundled services, usually with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan, including acute and psychiatric services, each requiring prior authorization. For inpatient hospital acute and psychiatric stays, you will pay a copay of $2055.00 and $2036.00 respectively, per admission or stay. Additional days, and non-Medicare covered stays for both acute and psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services have no copay and a 20% coinsurance. Observation Services have a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services have a 20% coinsurance. Outpatient Substance Abuse Services, including individual and group sessions, have a 20% coinsurance. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. There is no copay for ambulance services, but there is a 20% coinsurance for both ground and air ambulance services. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance. Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have a minimum and maximum coinsurance of 20%. Additional Telehealth Benefits have a copay of $0-$45. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as annual physical exams with no copay. Additional preventive services include Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices with no copay, and Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with 20% coinsurance. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Counseling Services, are not covered.
Hearing Services See details
Hearing exams and prescription hearing aids are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Routine hearing exams and fitting/evaluation for hearing aids have no copay, while prescription hearing aids have a plan-specified amount of $1,000 per year.
Vision Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance and no copay, while routine eye exams have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a $300 combined maximum plan benefit for all eyewear per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. 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), and oral and maxillofacial surgery are covered with no copay. Orthodontic services are covered up to a maximum of $1500 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Medical Supplies, Medicare-covered Prosthetic Devices, and Diabetic Supplies and Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Dual Access (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access (HMO-POS 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 Wellcare Dual Access (HMO-POS 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 by the Wellcare Dual Access (HMO-POS D-SNP) plan, with a $0 copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay, and Meal Benefits also have no copay with a doctor referral required. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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