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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 2026, 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 2026.
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 $31.70. 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 $570.00 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) prescription drug plan features an annual drug deductible of $570. For Tier 6 select care drugs, you will pay no copay regardless of whether you use standard or preferred pharmacies or mail order services. Tier 1 preferred generic and Tier 2 generic medications offer low copays starting at $18 and $19 respectively, with no copay for a three-month supply filled through preferred mail order. For Tier 3 preferred brand drugs, you will pay a 20% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply. Tier 4 non-preferred drugs require a copay starting at $100 for a one-month supply. Utilizing preferred pharmacies and preferred mail order delivery generally helps you secure the lowest cost sharing for your prescriptions.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan offers comprehensive coverage for essential medical services with predictable out-of-pocket costs, including no copay for primary care visits, home health services, and routine preventive care. For specialist visits, physical therapy, and urgent care, members pay a low $25 copay, while inpatient hospital stays require a daily copay for the first six days before transitioning to no copay. Outpatient hospital services and emergency care are also covered with no coinsurance, featuring copays ranging up to $300. This plan also provides valuable supplemental benefits, such as no copay for preventive dental care, routine hearing exams, and over-the-counter items. Members can take advantage of up to 24 one-way trips per year to plan-approved locations at no cost, alongside generous annual allowances of $300 for eyewear and $1,000 per ear for hearing aids. For specialized needs like durable medical equipment and dialysis services, a standard 20% coinsurance applies with no copay.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays require a $400 daily copay for days 1 to 6 and no copay for days 7 to 90, while psychiatric stays require a $300 daily copay for days 1 to 6 and no copay for days 7 to 90; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers outpatient services with no coinsurance, including outpatient hospital services with copays ranging from no copay to $300 and ambulatory surgical center services with a $200 copay. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers partial hospitalization with a $140.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Dual Reserve (HMO-POS D-SNP), featuring a $300 copay and no coinsurance for ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers emergency services with a $130 copay and urgently needed services with a $25 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers primary care physician services with no copay and no coinsurance, and telehealth services with a $0 to $25 copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, mental health, psychiatric, and opioid treatment services require prior authorization and carry a $25 copay with no coinsurance. Routine chiropractic care is partially covered at a $15 copay with no coinsurance for up to 12 visits yearly, while podiatry services are not covered.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams, alternative therapies, memory fitness, remote access technologies, and diabetes self-management. Kidney disease education is covered with no copay and a 20% coinsurance, though some supplemental benefits like health education and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) hearing services are partially covered, offering Medicare-covered exams for a $25 copay and no coinsurance, plus annual routine exams and fittings with no copay or coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), featuring eye exams with a $0 to $25 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a combined maximum plan benefit of $300 per year for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), requiring a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and other covered dental services. Prosthodontics (fixed and removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers diagnostic services with no coinsurance, offering lab services at no copay and diagnostic procedures with a $0 to $20 copay. Covered radiological services require prior authorization and include diagnostic radiology starting at no copay, therapeutic radiology with a minimum 20% coinsurance, and outpatient X-rays for a $50 copay.
Home Health Services See details
Home health services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) provides cardiac rehabilitation services with no coinsurance, although only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered under this benefit, carrying copayments of $40, $50, $35, and $25 respectively.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 to 20 and days 51 to 100, a $218 daily copay applies for days 21 to 50, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Dual Reserve (HMO-POS D-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture and meal benefits are not covered. Covered OTC items include nicotine replacement therapy and naloxone, which are available for reimbursement.
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