Wellcare Dual Access (HMO-POS D-SNP)
Wellcare Dual Access (HMO-POS D-SNP) H4073-002 Plan Details
Wellcare Dual Access (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc.
Plan ID: H4073-002
HelpAdvisor Editorial Team analysis of data from the 2025 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.
$0.00
Monthly Premium
Wellcare Dual Access (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc.
Plan ID: H4073-002
HelpAdvisor Editorial Team analysis of data from the 2025 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.
Wellcare Dual Access (HMO-POS D-SNP) H4073-002 Plan Details
Wellcare Dual Access (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc.
Plan ID: H4073-002
HelpAdvisor Editorial Team analysis of data from the 2025 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.
$0.00
Monthly Premium
North Carolina Counties Served
Iredell
Alamance
Davidson
Forsyth
Davie
Yadkin
Chatham
Surry
Duplin
Rowan
Wilkes
Vance
Stokes
Anson
Randolph
Rockingham
Polk
Montgomery
Moore
Caswell
Guilford
Harnett
Orange
Lee
Durham
Person
Richmond
Johnston
Wake
Wilson
Franklin
Warren
Nash
Transylvania
Graham
Gaston
Greene
Stanly
Lincoln
Catawba
Burke
Cleveland
Rutherford
Mecklenburg
Cabarrus
Mcdowell
Union
Swain
Sampson
Scotland
Hoke
Cumberland
Robeson
Columbus
Bladen
Ashe
Yancey
Caldwell
Alexander
Jackson
Avery
Watauga
Alleghany
Buncombe
Henderson
Mitchell
Haywood
Clay
Madison
Macon
Granville
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $9350 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | In-Network: Doctor Office Visit: Coinsurance for Primary Care Office Visit 0% - 20% |
| Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Coinsurance for Physician Specialist Office Visit 0% - 20% Prior Authorization Required for Doctor Specialty Visit Prior authorization required |
| Inpatient Hospital Care | In-Network: Acute Hospital Services: Copayment for Acute Hospital Services per Stay $0 - $1830 Prior Authorization Required for Acute Hospital Services Prior authorization required |
| Urgent Care | Copayment for Urgent Care $0 - $45 Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours Worldwide Coverage: Copayment for Worldwide Urgent Coverage $110 Maximum Plan Benefit of $50,000 |
| Emergency Room Visit | Copayment for Emergency Care $0 - $110 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $110 Maximum Plan Benefit of $50,000 |
| Ambulance Transportation | In-Network: Ground Ambulance: Coinsurance for Ground Ambulance Services 0% - 20% Air Ambulance: Coinsurance for Air Ambulance Services 0% - 20% Prior Authorization Required for Air Ambulance Prior authorization required |
Health Care Services and Medical Supplies
Wellcare Dual Access (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: Coinsurance for Medicare-covered Chiropractic Services 0% - 20% Prior Authorization Required for Chiropractic Services Prior authorization required |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Coinsurance for Medicare-covered Diabetic Supplies 0% - 20% Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 0% - 20% |
| Durable Medical Eqipment (DME) | In-Network: Coinsurance for Medicare-covered Durable Medical Equipment 0% - 20% Prior Authorization Required for Durable Medical Equipment Prior authorization required |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Coinsurance for Medicare-covered Diagnostic Procedures/Tests 0% - 20% Copayment for Medicare-covered Lab Services $0 or 0 Coinsurance for Medicare-covered Lab Services 0 or 20% Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 or 0 Coinsurance for Medicare-covered Diagnostic Radiological Services 0 or 20% Coinsurance for Medicare-covered Therapeutic Radiological Services 0% - 20% Coinsurance for Medicare-covered X-Ray Services 0% - 20% Prior authorization required |
| Home Health Care | In-Network: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services Prior authorization required |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0 - $1830 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required |
| Mental Health Outpatient Care | In-Network: Coinsurance for Medicare-covered Individual Sessions 0% - 20% Coinsurance for Medicare-covered Group Sessions 0% - 20% |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 or 0 Coinsurance for Medicare Covered Outpatient Hospital Services 0 or 20% Prior Authorization Required for Outpatient Hospital Services Outpatient Hospital and ASC Services Outpatient Hospital Services: The $0 co-payment is for diagnostic colonoscopy. The coinsurance is for all other outpatient services. Outpatient Observation Services: Coinsurance for Medicare Covered Observation Services 0% - 20% Ambulatory Surgical Center Services: Coinsurance for Ambulatory Surgical Center Services 0% - 20% Prior Authorization Required for Ambulatory Surgical Center Services Prior authorization required |
| Outpatient Substance Abuse Care | In-Network: Coinsurance for Medicare-covered Individual Sessions 0% - 20% Coinsurance for Medicare-covered Group Sessions 0% - 20% Prior Authorization Required for Outpatient Substance Abuse Services Prior authorization required |
| Over-the-counter (OTC) Items | OTC allowance of $144 every month is loaded into the Wellcare Spendables card on a monthly basis. Benefit is designed to allow members the flexibility to purchase OTC items at participating retailers, online, phone order, or catalog order. Benefit expires at end of month if unused. |
| Podiatry Services | In-Network: Coinsurance for Medicare-Covered Podiatry Services 0% - 20% Copayment for Routine Foot Care $0
Prior authorization required |
| Skilled Nursing Facility Care | 0 - $In-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $214 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services Prior authorization required |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network: Medicare Covered Preventive Dental: Coinsurance for Office Visit 0% - 20% Prior Authorization Required for Medicare Covered Preventive Dental Non-Medicare Covered Preventive Dental: Copayment for Non-medicare preventive $0 Copayment for Oral exams $0
Non-Medicare Covered Comprehensive Dental: Copayment for Non-medicare comprehensive $0 Copayment for Restorative services $0
Comprehensive services max plan benefit apply to both in-network and out-of-network services. Prior authorization required |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 or 0 Coinsurance for Medicare Covered Benefits 0 or 20% Copayment for Routine Eye Exams $0
Eyewear: Coinsurance for Medicare-Covered Benefits 0% - 20% Maximum Plan Allowance of $500 every year |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network: Hearing Exams: Coinsurance for Medicare Covered Benefits 0% - 20% Copayment for Routine Hearing Exams $0
Hearing Aids: Copayment for Hearing Aids $0
Prior authorization required |
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: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit |
