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Wellcare Fidelis Dual Align (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Fidelis Dual Align (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Fidelis Dual Align (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Fidelis Dual Align (HMO D-SNP) is a HMO D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in NJ. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Fidelis Dual Align (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Fidelis Dual Align (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Fidelis Dual Align (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellcare Fidelis Dual Align (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $54.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Wellcare Fidelis Dual Align (HMO D-SNP) has an annual drug deductible of $615. Tier 6 Select Care Drugs are highly affordable, offering no copay for any pharmacy type or supply duration. Tier 1 Preferred Generic and Tier 2 Generic drugs also feature no copay for three-month preferred mail-order fills, with one-month retail copays starting at $18 and $19 respectively. Brand-name and specialty medications are subject to coinsurance, with Tier 3 Preferred Brand drugs requiring 22% coinsurance and Tier 5 Specialty Tier drugs requiring 25% coinsurance for a one-month supply. Tier 4 Non-Preferred Drugs have copays ranging from $100 for a one-month supply up to $300 for a three-month supply. This clear drug formulary structure allows you to plan your healthcare costs effectively with the Wellcare Fidelis Dual Align (HMO D-SNP) plan.
Additional Benefits
The Wellcare Fidelis Dual Align (HMO D-SNP) plan covers inpatient hospital stays with a $2,050 copay per stay and no coinsurance, while most outpatient, primary care, specialist, and diagnostic services feature no copays and a 20% coinsurance. Emergency care is available with a $115 copay, and urgent care costs a $40 copay, both with no coinsurance. Additionally, home health services and select preventive care, such as fitness benefits, are covered with no copays and no coinsurance. For specialized needs, the plan provides diagnostic hearing exams and home infusion services with no copays and no coinsurance, alongside a monthly over-the-counter reimbursement of up to $196. Skilled Nursing Facility stays are also covered with no coinsurance, featuring no copays for days 1 to 20 and a $218 daily copay for days 21 to 70. However, routine dental, vision, hearing aids, and transportation services are not covered under this plan.
Inpatient Hospital See details
Wellcare Fidelis Dual Align (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with a $2,050 copayment per stay and no coinsurance. Prior authorization is required, and this benefit does not cover additional days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Wellcare Fidelis Dual Align (HMO D-SNP) covers outpatient services with no copays, although a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are also covered with no copay and a 20% coinsurance, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Wellcare Fidelis Dual Align (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Fidelis Dual Align (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Wellcare Fidelis Dual Align (HMO D-SNP) with a $115 copay and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency and urgent care are covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Fidelis Dual Align (HMO D-SNP) covers primary care, specialist visits, therapies, and mental health services with no copay and a 20% coinsurance, while telehealth services have a $0 to $40 copay and 20% coinsurance. However, podiatry services, routine chiropractic care, and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Wellcare Fidelis Dual Align (HMO D-SNP), offering an annual physical exam, fitness benefits, and alternative therapies with no copay and no coinsurance, plus kidney education and select screenings for a 20% coinsurance and no copay. Non-covered services include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Fidelis Dual Align (HMO D-SNP) covers diagnostic hearing exams with no copay, no coinsurance, and no deductible, although prior authorization is required. Routine hearing exams, fitting evaluations, and all prescription and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are covered by Wellcare Fidelis Dual Align (HMO D-SNP) with no copay, no deductible, and a 20% coinsurance with prior authorization required for exams, though some services are covered while routine eye exams, other eye exam services, contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Wellcare Fidelis Dual Align (HMO D-SNP) partially covers dental services, offering coverage only for Medicare-covered dental services with no copay and a 20% coinsurance. Routine preventive, diagnostic, restorative, and orthodontic dental services are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Fidelis Dual Align (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Fidelis Dual Align (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Fidelis Dual Align (HMO D-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Fidelis Dual Align (HMO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required. This coverage applies to all diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered under the Wellcare Fidelis Dual Align (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Fidelis Dual Align (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but in practice, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Fidelis Dual Align (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 to 20 and days 71 to 100, a $218 daily copay for days 21 to 70, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Fidelis Dual Align (HMO D-SNP) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to $196 monthly via reimbursement. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
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