A non-government entity
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 KY. This plan received an overall rating of 3.5 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 $49.60. 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:
Sign up for Wellcare Dual Access (HMO-POS D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Dual Access (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs, which vary depending on the drug tier and pharmacy. Once your total drug costs reach $2000, you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $49.60. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellcare Dual Access (HMO-POS D-SNP) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a high copay, while outpatient services often involve coinsurance. Emergency services have a copay, and ambulance services have coinsurance, but transportation to health-related locations is available at no cost. Preventive services, including an annual physical, and many vision and dental services are covered with no copay. Hearing exams and hearing aids are available with no copay, and prescription hearing aids are covered up to $1500 per year. The plan also covers home health services and offers no copay for over-the-counter items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. The plan has a copay of $1875 per admission or stay, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a 20% coinsurance and no copay, observation services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) services with a minimum 20% coinsurance. Outpatient Substance Abuse Services, including individual and group sessions, are covered with a minimum 20% coinsurance. Outpatient Blood Services are also covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Dual Access (HMO-POS D-SNP) plan, 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. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under 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, and there is no coinsurance for any of these services.
Primary Care See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers primary care physician services with 20% coinsurance, chiropractic services with no copay, occupational therapy services with 20% coinsurance, and physician specialist services with 20% coinsurance. Mental health specialty, podiatry, other health care professional, psychiatric, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services are also covered with 20% coinsurance.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other preventive services with a 20% coinsurance. Additional services like Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices have no copay.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $1500 per year, with no copay for all types.
Vision Services See details
The Wellcare Dual Access (HMO-POS D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay. Eyewear is covered with a 20% coinsurance, with contact lenses covered with no copay and no coinsurance. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
Dental services are covered, with Medicare Dental Services subject to a 20% coinsurance. Other dental services include 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, all with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum plan benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Dual Access (HMO-POS D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by 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. However, 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. 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 by the Wellcare Dual Access (HMO-POS D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the Wellcare Dual Access (HMO-POS D-SNP) plan, 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. Over-the-counter items and meal benefits are covered with no copay, and a doctor's referral is required for meal benefits.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved