Wellpoint Dual Advantage (D-SNP) Plan Details for Columbia County, WA
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*CMS rated this Wellpoint plan (H1894-011-0) 2.5 (Below Average) out of 5 stars.
Wellpoint Dual Advantage (D-SNP) is a Dual-Eligible Medicare Advantage Special Needs Plan. The 2025 Annual Enrollment period starts October 15. Plan benefits begin January 1.
The delivery of healthcare services and costs by Wellpoint is different than Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Only individuals who meet all Dual-Eligible SNP qualification requirements are eligible to join this D-SNP plan.
Plan Basics | |
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Plan ID: | H1894-011-0 |
Plan Type: | HMO D-SNP |
Plan Year: | 2025 |
Premium: | $0.00/mo Plus your Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | 9,350.00 /yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | $590.00 deductible |
Supplemental Benefits: | Vision, Hearing |
Availability: | Columbia County, WA |
Insured By: | Wellpoint |
Summary of Benefits |
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Health Plan Cost Sharing & Benefits
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Wellpoint plan:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | $0 Copay Prior Authorization Required, Referral Required |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | 20% Coinsurance Prior Authorization Required, Referral Required |
Routine foot care: | $0 Copay Prior Authorization Required, Referral Required |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | 20% Coinsurance Prior Authorization Required, Referral Required |
Routine chiropractic care: | $0 |
Emergency Care / Urgent Care | |
Emergency room care: | $90 Copay |
Urgent care: | $45 Copay |
Ground ambulance: | 20% Coinsurance |
Inpatient hospital coverage: | Coming Soon |
Outpatient hospital coverage: | 20% Coinsurance Prior Authorization Required, Referral Required |
Skilled Nursing Facility: | Unknown |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | 20% Coinsurance |
Outpatient group therapy visit with a psychiatrist: | 20% Coinsurance |
Inpatient hospital - psychiatric: | Coming Soon |
Outpatient group therapy visit: | 20% Coinsurance |
Outpatient individual therapy visit: | 20% Coinsurance Prior Authorization Required, Referral Required |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | 20% Coinsurance Prior Authorization Required, Referral Required |
Occupational therapy visit: | 20% Coinsurance Prior Authorization Required, Referral Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 Copay |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | 20% Coinsurance Prior Authorization Required, Referral Required |
Lab services: | 20% Coinsurance Prior Authorization Required, Referral Required |
Outpatient x-rays: | 20% Coinsurance Prior Authorization Required, Referral Required |
Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required, Referral Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Wellpoint Dual Advantage Summary of Benefits information.
Supplemental Health Plan Benefits (H1894-011-0)
The following is a summary of the supplemental benefits Wellpoint includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Covered Limits may apply |
Vision | Maximum vision benefit: | $2.00 Every three years |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | Not Covered |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the details of this plan's prescription drug plan premium.
Basic Part D Premium: | |
Supplemental Part D Premium: | |
Total Part D Premium: | |
Part D Premium with Full LIS Assistance: |
The Social Security Extra Help page has more information about the low-income subsidy (LIS) and how to enroll in the program.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. This is the amount you must pay at the pharmacy before Wellpoint begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Wellpoint Dual Advantage has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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$0 copay on all covered generic and brand-name prescriptions. |
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this Wellpoint plan.
CMS Measure | Star Rating |
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2025 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | Not enough data available |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | Not enough data available |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | Not enough data available |
Drug Safety and Accuracy of Drug Pricing |
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Wellpoint
Plan Website: | https://shop.wellpoint.com/medicare |
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Formulay Information: | http://www.myamerigroup.com/medicare |
Pharmacy Information: | Wellpoint Pharmacy Page |
Prospective Members: | (833)668-0683 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Medicare Advantage Special Needs Plans (SNPs) are generally incompatible with most other health insurance options. Enrolling in an SNP plan while having Medicare Part A and/or Medicare Part B will result in disenrollment from Original Medicare. Additionally, it is not possible to simultaneously hold a Medicare Supplement Insurance policy and be part of an SNP plan.
With a D-SNP, members keep the same Medicaid plan and Medicaid benefits. If you are a Veteran and have VA Health Benefits, you may be able to care from your local VA hospital.
Citations & References
- Wellpoint, https://shop.wellpoint.com/medicare, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in Washington", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.