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Wellpoint Dual Advantage (HMO-POS D-SNP)

Wellpoint Dual Advantage (HMO-POS D-SNP) H0907-002 Plan Details
3.5 out of 5 stars

Wellpoint Dual Advantage (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellpoint
Plan ID: H0907-002

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$27.20
Monthly Premium

Wellpoint Dual Advantage (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellpoint
Plan ID: H0907-002

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Wellpoint Dual Advantage (HMO-POS D-SNP) H0907-002 Plan Details
3.5 out of 5 stars

Wellpoint Dual Advantage (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellpoint
Plan ID: H0907-002

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$27.20
Monthly Premium

Iowa Counties Served

Adair Woodbury Muscatine Buchanan Jefferson Madison Cass Crawford Calhoun Montgomery Kossuth Lucas Poweshiek Clayton Mills Butler Cedar Benton Clinton Davis Hardin Page Union Linn Jones Henry Tama Winnebago Story Osceola Fayette Mahaska Burt Ringgold Dubuque Audubon Lee Guthrie Emmet Black Hawk Fremont Sioux Van Buren Sac Franklin Carroll Wayne Delaware Mitchell Dickinson Ida Boone Jackson Monroe Webster Johnson Jasper Shelby Obrien Clay Allamakee Plymouth Humboldt Warren Grundy Howard Washington Bremer Pottawattamie Marion Winneshiek Taylor Dallas Lyon Cherokee Pocahontas Adams Scott Appanoose Iowa Wapello Decatur Louisa Harrison Palo Alto Clarke Hancock Hamilton Marshall Floyd Monona Des Moines Chickasaw Polk Worth Cerro Gordo Greene Keokuk Wright

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $3900
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
In-Network:
$0.00 copay
Specialty Doctor Visit
In-Network:
$25.00 copay
Inpatient Hospital Care
In-Network:
Days 1-5: $295.00 per day, per admission / Days 6-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
Urgent Care
Urgent Care: $20.00 copay
Emergency Room Visit
Emergency Care: $90.00 copay
Worldwide Coverage: This plan covers urgent care and emergency services when traveling outside of the United States for less than six months. This benefit is limited to $100,000.00 per year.
Ambulance Transportation
Ground Ambulance: $280.00 copay Per Trip
Air Ambulance: $280.00 copay

Health Care Services and Medical Supplies

Wellpoint Dual Advantage (HMO-POS D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Medicare Covered Chiropractic Services: $20.00 copay
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Diabetic Supplies: $0.00 copay
Durable Medical Eqipment (DME)
In-Network:
20% coinsurance
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:
Lab Services: $0.00 copay
X-Rays: $20.00 copay
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: $0.00 copay - $25.00 copay
Diagnostic Radiological Services: $25.00 copay - $195.00 copay
Home Health Care
In-Network:
$0.00 copay
Mental Health Inpatient Care
In-Network:
Days 1-5: $295.00 per day, per admission / Days 6-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
Mental Health Outpatient Care
In-Network:
Individual and Group Sessions: $25.00 copay
Outpatient Services / Surgery
In-Network:
Outpatient Hospital - Surgery: $295.00 copay
Observation Services: $295.00 copay
Ambulatory Surgical Center: $215.00 copay
Outpatient Substance Abuse Care
In-Network:
Individual and Group Sessions: $25.00 copay
Podiatry Services
In-Network:
Medicare Covered Podiatry Services: $0.00 copay - $25.00 copay
Routine Foot Care: $0.00 copay
Unlimited routine foot care visits each year.
Skilled Nursing Facility Care
In-Network:
Days 1 - 20: $0.00 per day / Days 21 - 100: $203.00 per day

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network and POS (Out-of-Network):
Preventive and Comprehensive Dental Combined Allowance
This plan covers up to $2,000 for covered preventive and comprehensive dental services every year.

In-Network:
Medicare Covered Dental: $0.00 copay
Preventive Dental Services: $0.00 copay
Comprehensive Dental Services: $0.00 copay

POS (Out-of-Network):
Non-Medicare Covered Dental Services:
Preventive Dental Services: $0.00 copay
Comprehensive Dental Services: $0.00 copay

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:
Medicare Covered Eye Exam: $0.00 copay - $25.00 copay
Routine Eye Exam: $0.00 copay
This plan covers 1 routine eye exam(s) every year.
Medicare Covered Eye Wear: $0.00 copay
Routine Eye Wear: $0.00 copay
This plan covers up to $250.00 for eyeglasses or contact lenses every year.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:
Medicare Covered Hearing Exam: $25.00 copay
Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount.
This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $2,000.00 maximum plan benefit for prescribed hearing aids every year.

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services

Prescription Drug Costs and Coverage

The Wellpoint Dual Advantage (HMO-POS D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $0
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Generic
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Preferred Brand
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Non-Preferred Drug
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Specialty Tier
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Select Care Drugs
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Annual Drug Deductible $0
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Generic
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Preferred Brand
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Non-Preferred Drug
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Specialty Tier
  • Preferred cost-share retail N/A
  • Standard mail order N/A
  • Standard retail N/A
Select Care Drugs
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Annual Drug Deductible $0
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Generic
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Preferred Brand
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Non-Preferred Drug
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
Specialty Tier
  • Preferred cost-share retail N/A
  • Standard mail order N/A
  • Standard retail N/A
Select Care Drugs
  • Preferred cost-share retail $0.00
  • Standard mail order $0.00
  • Standard retail $0.00
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