Wellpoint Dual Advantage (HMO D-SNP)

Texas Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)


Monthly Premium

Your Cost
$18
by Wellpoint

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.5
out of 5 stars

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Plan Name
Wellpoint Dual Advantage (HMO D-SNP)
Insurance Carrier
Wellpoint
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

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

Monthly Premium
$18
Annual Deductible
$0
Max Out-of-Pocket
$9,350
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 or $90 copay per visit (always covered)
Ambulance
0% or 20% coinsurance

Wellpoint Dual Advantage (HMO D-SNP) has a monthly premium cost of $18 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $9,350 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Wellpoint Dual Advantage (HMO D-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

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

Medicare Advantage health plans can offer even more additional benefits. Wellpoint Dual Advantage (HMO D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Limited coverage
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Wellpoint Dual Advantage (HMO D-SNP) received an overall government quality rating of 3.5 stars out of 5 stars.

Wellpoint Dual Advantage (HMO D-SNP) performed worse than Texas’s State average overall quality score of 3.8 stars.

This Plan’s 5-star Gov’t Quality Score
Texas State Average Score
Overall Government 5 Star Quality Rating
 3.5
 3.8
Summary rating of health plan quality
 3.5
 3.6
Staying healthy: screenings, tests, & vaccines
 4
 3.6
Managing chronic (long term) conditions
 3
 3.4
Member experience with health plan
(coming soon)
 3.8
Member complaints & changes in the health plan's performance
 3
 3.4
Health plan customer service
 5
 4.4
Summary rating of drug plan quality
 3.5
 3.6
Drug plan customer service
 5
 4.2
Member complaints & changes in the drug plan's performance
 4
 3.4
Member experience with the drug plan
(coming soon)
 4.2
Drug safety & accuracy of drug pricing
 3
 3.3

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Wellpoint Dual Advantage (HMO D-SNP) received 3.5 stars for its health plan quality score which is worse than the Texas State average health plan quality score of 3.6 stars.

Wellpoint Dual Advantage (HMO D-SNP) received 3.5 stars for its drug plan quality score which is worse than the Texas State average drug plan quality score of 3.6 stars.


Monthly Premium
$18
Health Portion of Premium
$0
Drug Portion of Premium
$18
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$9,350 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$0 copay

Tests, labs, & imaging

Diagnostic tests & procedures
0% or 20% coinsurance
Lab services
0% or 20% coinsurance
Diagnostic radiology services (like MRI)
0% or 20% coinsurance
Outpatient x-rays
0% or 20% coinsurance
Emergency care
$0 or $90 copay per visit (always covered)
Urgent care
$0 or $45 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
Coming soon
Outpatient hospital coverage
0% or 20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
Coming soon

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
0% or 20% coinsurance

Therapy services

Occupational therapy visit
0% or 20% coinsurance
Physical therapy & speech & language therapy visit
0% or 20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
0% or 20% coinsurance
Outpatient individual therapy with a psychiatrist
0% or 20% coinsurance
Outpatient group therapy visit
0% or 20% coinsurance
Outpatient individual therapy visit
0% or 20% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
0% or 0-20% coinsurance per item
Prosthetics (like braces, artificial limbs)
0% or 20% coinsurance per item
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25% coinsurance

Brand-name drugs :
25% coinsurance


Generic drugs :
0% coinsurance

Brand-name drugs :
0% coinsurance

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
0% or 0-20% coinsurance
Other Part B drugs
0% or 0-20% coinsurance

Hearing

Hearing exam
0% or 20% coinsurance
Fitting/evaluation
$0 copay
Hearing aids - All types
$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
In-network: $0 copay
Out-of-network: $0 copay
Implant services
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
Not covered

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