Wellpoint Full Dual Advantage (HMO D-SNP)

by Wellpoint

2026 Medicare-Medicaid Dual Eligible D-SNP plan available in Tennessee

Plan ID H5828-002-0

Additional coverage:

RxHearingVisionDental

Medicare-Medicaid Dual Eligible D-SNP HMO $0 premium 3.0 Overall

Monthly plan premium $0 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $9,250 / yr

Drug deductible $615 / yr

3.0 Overall Government Star Rating 2026 · out of 5 stars

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Plan Overview

Wellpoint Full Dual Advantage (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Tennessee and offered by the health insurance company Wellpoint. This plan's network type is HMO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name Wellpoint Full Dual Advantage (HMO D-SNP)

Insurance Carrier Wellpoint

Plan Type Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)

Network Type HMO

Cost Summary

Wellpoint Full Dual Advantage (HMO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $9,250. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $0 / mo

Health portion of premium $0

Drug portion of premium $0

Annual Deductible $0 / yr

Max Out-of-Pocket · in-network $9,250 / yr

Primary doctor visit $0 copay

Specialist visit $0 copay

ER visit $0 copay

Ambulance $0 copay

Additional Benefits and Coverage

Wellpoint Full Dual Advantage (HMO D-SNP) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Wellpoint Full Dual Advantage (HMO D-SNP) includes coverage for hearing, vision, dental.

Part D Prescription Drug Coverage Yes

Dental Yes

Vision Yes

Hearing Yes

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Limited coverage

In-home support services Not covered

Home & bathroom safety devices Limited coverage

Meals for short duration Limited coverage

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: $0 copay
Out-of-network: $0 copay

Specialist visit In-network: $0 copay
Out-of-network: $0 copay

Tests, labs & imaging

Diagnostic tests & procedures In-network: $0 copay
Out-of-network: $0 copay

Lab services In-network: $0 copay
Out-of-network: $0 copay

Diagnostic radiology services (like MRI) In-network: $0 copay
Out-of-network: $0 copay

Outpatient x-rays In-network: $0 copay
Out-of-network: $0 copay

Emergency care $0 copay

Urgent care $0 copay

Hospital Services

Inpatient hospital coverage Tier 1
$0 per day for days 1-60
$0 per day for days 61-90
$0 per day for days 91-150

Outpatient hospital coverage In-network: $0 copay
Out-of-network: $0 copay

Skilled nursing facility

Skilled nursing facility Tier 1
$0 per day for days 1-20
$217 per day for days 21-100

Preventive services

Preventive services In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance In-network: $0 copay
Out-of-network: $0 copay

Therapy services

Occupational therapy visit In-network: $0 copay
Out-of-network: $0 copay

Physical therapy & speech & language therapy visit In-network: $0 copay
Out-of-network: $0 copay

Mental health services

Outpatient group therapy with a psychiatrist In-network: $0 copay
Out-of-network: $0 copay

Outpatient individual therapy with a psychiatrist In-network: $0 copay
Out-of-network: $0 copay

Outpatient group therapy visit In-network: $0 copay
Out-of-network: $0 copay

Outpatient individual therapy visit In-network: $0 copay
Out-of-network: $0 copay

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: $0 copay
Out-of-network: $0 copay

Prosthetics (like braces, artificial limbs) In-network: $0 copay
Out-of-network: $0 copay

Diabetes supplies In-network: $0 copay
Out-of-network: $0 copay

Prescription drugs (Part D benefits)

Drug tier standard retail · 1-month supply Initial coverage Catastrophic

Preferred Generic $0.00 copay $0 copay

Generic 25% coinsurance $0 copay

Preferred Brand 25% coinsurance $0 copay

Non-Preferred Drug 25% coinsurance $0 copay

Specialty Tier 25% coinsurance $0 copay

Part B drugs

Chemotherapy drugs In-network: $0 copay
Out-of-network: $0 copay

Other Part B drugs In-network: $0 copay
Out-of-network: $0 copay

Medicare star rating

Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Wellpoint Full Dual Advantage (HMO D-SNP) earned an overall rating of 3.0 stars — worse than Tennessee's state average of 3.5 stars.

Rating category This plan State average

Overall star rating ★ 3.0 3.5

Health plan quality

Summary rating of health plan quality ★ 3.0 3.5

Staying healthy: screenings, tests & vaccines ★ 2.0 2.4

Managing chronic (long-term) conditions ★ 2.0 3.0

Member experience with health plan ★ 3.0 4.2

Member complaints & changes in performance ★ 3.0 3.8

Health plan customer service ★ 5.0 4.0

Drug plan quality

Summary rating of drug plan quality ★ 3.0 3.3

Drug plan customer service ★ 5.0 4.8

Member complaints & changes in performance ★ 3.0 3.6

Member experience with the drug plan ★ 4.0 4.6

Drug safety & accuracy of drug pricing ★ 3.0 3.1

Extra Benefits

Hearing

Hearing exam In-network: $0 copay
Out-of-network: $0 copay

Fitting/evaluation In-network: $0 copay
Out-of-network: $0 copay

Hearing aids - prescription In-network: $0 copay
Out-of-network: $0 copay

Hearing aids - over the counter In-network: $0 copay
Out-of-network: $0 copay

Preventive dental

Oral exam In-network: $0 copay
Out-of-network: $0 copay

Cleaning In-network: $0 copay
Out-of-network: $0 copay

Fluoride treatment In-network: $0 copay
Out-of-network: $0 copay

Dental x-rays In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services In-network: $0 copay
Out-of-network: $0 copay

Endodontics In-network: $0 copay
Out-of-network: $0 copay

Periodontics In-network: $0 copay
Out-of-network: $0 copay

Prosthodontics, removable In-network: $0 copay
Out-of-network: $0 copay

Prosthodontics, fixed In-network: $0 copay
Out-of-network: $0 copay

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery In-network: $0 copay
Out-of-network: $0 copay

Orthodontics Not covered

Adjunctive general services In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam In-network: $0 copay
Out-of-network: $0 copay

Contact lenses In-network: $0 copay
Out-of-network: $0 copay

Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass frames (only) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass lenses (only) In-network: $0 copay
Out-of-network: $0 copay

Upgrades Not covered

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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