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Wellcare Dual Reserve (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (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 Reserve (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Reserve (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 Reserve (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 Reserve (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 Reserve (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 Reserve (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 $5000.00 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 Reserve (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your prescriptions. This plan's premium may be reduced if you qualify for the low-income subsidy. Once your total drug costs reach $2,000, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for your Medicare Part D covered drugs, but you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $300 copay for days 1-6, with no copay for the remaining days. Outpatient services have copays ranging from $0 to $300. Emergency services have a $125 copay, and primary care visits have no copay. Preventive services, including hearing and vision exams, often have no copay. Dental services, including exams and cleanings, are covered with no copay, while hearing aids are covered up to $1000 per year. The plan also provides coverage for home health services, skilled nursing facilities, and medical equipment, with some services incurring a copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $300 for days 1-6 and no copay for days 7-90. Additional days for inpatient hospital-acute, non-Medicare-covered stays for inpatient hospital-acute, upgrades for inpatient hospital-acute, additional days for inpatient hospital psychiatric, and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay of $0-$300, observation services with a copay of $125-$300, ambulatory surgical center (ASC) services with a $200 copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Ground and air ambulance services have a $300 copay, and transportation services to a plan-approved health-related location have no copay for up to 24 one-way trips per year, using rideshare, bus/subway, or medical transport; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $25 copay, and all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $25 copay.
Preventive Services See details
Preventive services include no copay for annual physical exams and glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Additional preventive services, including Personal Emergency Response System (PERS), Alternative Therapies, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications, are covered with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $25 copay, routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered with no copay up to $1000 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, up to a combined maximum of $300 every year. Routine eye exams have no copay and are covered once per year.
Dental Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers Medicare Dental Services with a $25 copay, and other dental services including oral exams, dental x-rays, and other diagnostic dental services with no copay. Additionally, the plan covers prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay. However, the plan does not cover prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices also has a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $20, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Reserve (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 Reserve (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 under the Wellcare Dual Reserve (HMO-POS D-SNP) plan, requiring prior authorization. For days 1-20, there is no copay, for days 21-50 there is a $214 copay, and for days 51-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services for the Wellcare Dual Reserve (HMO-POS D-SNP) plan cover over-the-counter (OTC) items with no copay, but acupuncture, meal benefits, 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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