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Wellpoint Dual Advantage (HMO D-SNP) Medicare Special Need Plan H1212-002 • 2027

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$6440.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $105.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
0 beneficiaries
Last update:

Introduction

Wellpoint Dual Advantage is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Wellpoint. The plan uses a Health Maintenance Organization (HMO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $0.00 monthly premium, $0.00 medical deductible, and $6440.00 in-network maximum out-of-pocket. CMS Plan ID H1212-002 identifies this plan. The 2027 Part D prescription drug deductible is $105.00.

CMS reports 0 beneficiaries enrolled across all service areas. You must live in the plan's service area to enroll: See List.

Eligibility

Wellpoint Dual Advantage is a Dual Eligible Special Needs Plan (D-SNP) designed for individuals enrolled in both Medicare and Medicaid.

Special Needs Plan Type
Dual-Eligible Special Needs Plan (D-SNP)
Medicare Requirement
Medicare Part A and Part B
Special Needs Requirement
Must qualify for Medicaid
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Plan Benefits

Wellpoint Dual Advantage has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H1212-002.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay In-network: $0 copay
Specialist In-network: $0 or $25 copay In-network: $0 or $25 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay In-network: $0 copay
Telehealth benefit In-network: $0 copay In-network: $0 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay In-network: $0 copay
Health transportation (non-emergency) Coming soon In-network: $0 copay

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0 or $30-$150 copay In-network: $0 or $30-$150 copay
Lab services In-network: $0 copay In-network: $0 copay
Outpatient x-rays In-network: $0 or $50 copay In-network: $0 or $50 copay
Diagnostic tests and procedures In-network: $0 or $0-$85 copay In-network: $0 or $0-$85 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $0 or $130 copay $0 or $130 copay
Worldwide emergency care Coming soon $0 copay
Urgent care $0 or $20 copay $0 or $20 copay
Inpatient hospital care Tier 1
$0 or $295 per day for days 1-7
$0 per day for days 8-90
$0 per stay		 Tier 1
$0 or $295 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Skilled Nursing Facility Tier 1
$0 per day for days 1-20
$0 or $221 per day for days 21-100		 Tier 1
$0 per day for days 1-20
$0 or $218 per day for days 21-100
Ground ambulance In-network: $0 or $260 copay In-network: $0 or $260 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $0 or $25 copay In-network: $0 or $25 copay
Outpatient group therapy In-network: $0 or $25 copay In-network: $0 or $25 copay
Inpatient psychiatric hospital care Tier 1
$0 or $295 per day for days 1-7
$0 per day for days 8-90
$0 per stay		 Tier 1
$0 or $295 per day for days 1-7
$0 per day for days 8-90
$0 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $0 or $25 copay In-network: $0 or $25 copay
Occupational therapy In-network: $0 or $25 copay In-network: $0 or $25 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay In-network: $0 copay
Durable medical equipment In-network: 0% or 20% coinsurance In-network: 0% or 0%-20% coinsurance
Prosthetics In-network: 0% or 20% coinsurance In-network: 0% or 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0% or 0%-20% coinsurance In-network: 0% or 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0% or 0%-20% coinsurance In-network: 0% or 0%-20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay In-network: $0 copay
Dental x-rays In-network: $0 copay In-network: $0 copay
Cleaning In-network: $0 copay In-network: $0 copay
Periodontics In-network: $0 copay In-network: $0 copay
Endodontics In-network: $0 copay In-network: $0 copay
Restorative services In-network: $0 copay In-network: $0 copay
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: $0 copay In-network: $0 copay

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay In-network: $0 copay
Contact lenses In-network: $0 copay In-network: $0 copay
Eyeglass frames only In-network: $0 copay In-network: $0 copay
Eyeglass lenses only In-network: $0 copay In-network: $0 copay
Eyeglasses (frames & lenses) In-network: $0 copay In-network: $0 copay
Upgrades Not covered Not covered

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay In-network: $0 copay
Fitting/evaluation In-network: $0 copay In-network: $0 copay
Prescription hearing aids In-network: $0 copay
You can choose for this plan to cover
either
your prescription or over-the-counter hearing aids each year, but
not
both.		 In-network: $0 copay
OTC hearing aids In-network: $0 copay
You can choose for this plan to cover
either
your prescription or over-the-counter hearing aids each year, but
not
both.		 In-network: $0 copay

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon In-network: $0 copay
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices In-network: $0 copay In-network: $0 copay

Certain preventive services are covered 100% by Wellpoint Dual Advantage as a Part B benefit.

Prescription Drug Coverage

Wellpoint Dual Advantage includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

Wellpoint Dual Advantage (H1212-002-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($9.60)
Supplemental Part D Premium:$9.60
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$12.80
Low-Income Premium Subsidy Paid by CMS:$0.00
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $105.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Wellpoint starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Wellpoint Dual Advantage may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Wellpoint Dual Advantage (H1212-002-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$0.00 copay25% coinsurance
Preferred Brand25% coinsurance25% coinsurance
Non-Preferred Drug25% coinsurance25% coinsurance
Specialty Tier32% coinsurance25% coinsurance
Select Care DrugsNot available$0.00 copay
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H1212)

CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.

2027 Medicare Star Ratings for Contract H1212
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Plan too new to be measured
Managing Chronic (Long Term) Conditions Plan too new to be measured
Member Experience with Health Plan Plan too new to be measured
Complaints and Changes in Plans Performance Plan too new to be measured
Health Plan Customer Service Plan too new to be measured
Drug Plan Customer Service Plan too new to be measured
Complaints and Changes in the Drug Plan Plan too new to be measured
Member Experience with the Drug Plan Plan too new to be measured
Drug Safety and Accuracy of Drug Pricing Plan too new to be measured
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services CY2027 Landscape (202609.1)
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2027 Star Ratings Data Tables
Plan Benefits Package Centers for Medicare & Medicaid Services PBP Benefits-2027
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-09

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Wellpoint (official source) https://shop.wellpoint.com/med October 4, 2026
CMS.gov Dual Eligible Special Needs Plans (D-SNPs) April 28, 2026
CMS.gov Medicare Advantage Plan Fact Sheet April 28, 2026
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage April 28, 2026

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.