Wellpoint Full Dual Advantage (HMO D-SNP)
Wellpoint Full Dual Advantage (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Wellpoint
Plan ID: H3240-013
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 Full Dual Advantage (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Wellpoint
Plan ID: H3240-013
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.
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $-1 |
Out of Pocket Max |
In-Network: $8850 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: $0.00 copay |
Inpatient Hospital Care | In-Network: $0.00 copay per stay |
Urgent Care | Urgent Care: $0.00 copay |
Emergency Room Visit | Emergency Care: $0.00 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: $0.00 copay Per Trip Air Ambulance: $0.00 copay |
Health Care Services and Medical Supplies
Wellpoint Full Dual Advantage (HMO 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: $0.00 copay |
Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies: $0.00 copay |
Durable Medical Eqipment (DME) | In-Network: $0.00 copay |
Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Lab Services: $0.00 copay X-Rays: $0.00 copay Therapeutic Radiological Services: $0.00 copay Outpatient Diagnostic Procedures/Tests: $0.00 copay Diagnostic Radiological Services: $0.00 copay |
Home Health Care | In-Network: $0.00 copay |
Mental Health Inpatient Care | In-Network: $0.00 copay per stay |
Mental Health Outpatient Care | In-Network: Individual and Group Sessions: $0.00 copay |
Outpatient Services / Surgery | In-Network: Outpatient Hospital - Surgery: $0.00 copay Observation Services: $0.00 copay Ambulatory Surgical Center: $0.00 copay |
Outpatient Substance Abuse Care | In-Network: Individual and Group Sessions: $0.00 copay |
Podiatry Services | In-Network: Medicare Covered Podiatry Services: $0.00 copay |
Skilled Nursing Facility Care | In-Network: $0.00 copay per stay |
Dental Benefits
The following dental services are covered from in-network providers.
Coverage | Cost |
---|---|
Dental Care | Medicare Covered Dental: $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 Medicare Covered Eye Wear: $0.00 copay |
Hearing Benefits
The following hearing services are covered from in-network providers.
Coverage | Cost |
---|---|
Hearing Benefits | In-Network: Medicare Covered Hearing Exam: $0.00 copay |
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 Full Dual Advantage (HMO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of N/A per year.
Coverage |
Cost
|
---|---|
Coverage & Cost
|
|
Annual Drug Deductible | N/A |
Preferred Generic |
|
Generic |
|
Select Care Drugs |
|
Annual Drug Deductible | N/A |
Preferred Generic |
|
Generic |
|
Select Care Drugs |
|
Annual Drug Deductible | N/A |
Preferred Generic |
|
Generic |
|
Select Care Drugs |
|