Coordination of Medicaid and Medicare Benefits for Dual Eligible Special Needs Plan (D-SNP) Members

A WellCare Dual Eligible Special Needs Plan (D-SNP) is a special type of Medicare Advantage plan designed to provide extra support and benefits at no additional cost to individuals who qualify for both Medicaid and Medicare coverage.

In 2025, WellCare in Iowa is offering three D-SNP plans, tailored to different levels of Medicaid eligibility. D-SNP members may be full-benefit duals (eligible for full Medicaid benefits) or partial-benefit duals (only eligible for assistance with some or all Medicare premium and cost-sharing). WellCare’s three distinct plans based on full or partial-dual status make it easy to identify D-SNP members.

Wellcare Dual Liberty (full-benefit dual)
Wellcare Dual Access
Wellcare Dual Reserve

When accessing Availity, providers can select Wellcare from the dropdown menu to verify membership as well.

Model of Care and Provider Coordination

Our Model of Care Plan is a comprehensive care management model designed to enhance care coordination through intense engagement, targeted interventions, and strong partnerships with providers. The composition of D-SNP member-centric Interdisciplinary Care Team’s includes provider participation, ensuring Medicaid benefits and care coordination are properly managed. As a provider, you are required to follow coordination and cost sharing requirements, which vary by each D-SNP plan.

Below is a table summarizing D-SNP member plans and coordination information:

2025 Plan Name	Medicaid Benefits	Who do I coordinate with	Balance Billing
Wellcare Dual Liberty (HMO-POS D-SNP)	Full Medicaid Benefits Eligible for Medicaid benefits and services which may be provided by Iowa Total Care or another Medicaid MCO.	Aligned members have Wellcare and affiliated Iowa Total Care. Unaligned members have WellCare and another Medicaid MCO, not Iowa Total Care.	Prohibited from balance billing.
Wellcare Dual Access (HMO-POS D-SNP)	Partial Medicaid Benefits Members only receives premium and cost sharing assistance. Not enrolled in Medicaid Healthcare plan	Wellcare for Medicare. Not enrolled in Medicaid healthcare plan.	Prohibited from balance billing.
Wellcare Dual Reserve (HMO-POS D-SNP)	Partial Medicaid Benefits Members only receives premium and cost sharing assistance. Not enrolled in Medicaid Healthcare plan	Wellcare for Medicare. Not enrolled in Medicaid healthcare plan.	Prohibited from balance billing. There may be some instances where members are responsible for only cost sharing amounts.

Model of Care Training Reminder

CMS requires all providers to complete annual Model of Care training within 30-days of contract effective date and annually thereafter. This National Committee for Quality Assurance (NCQA)-approved training outlines essential information and provides guidance on collaborating with our clinical team to support WellCare D-SNP members.

For questions, please contact your local Provider Engagement Account Manager or members can contact the Wellcare Duals Special Needs Plans Member Services 1-833-444-9089 (TTY 711).

Additional Resources

Provider Resources - Medicare Advantage Provider Manual
Wellcare Policies

Providers