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Wellcare Sunshine Health Dual Align (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Sunshine Health 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 Sunshine Health Dual Align (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Sunshine Health Dual Align (HMO D-SNP) is a HMO D-SNP plan offered by Centene Corporation available for enrollment in 2026 to people living in Select counties in FL. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Wellcare Sunshine Health 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 Sunshine Health 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 Sunshine Health 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 Sunshine Health Dual Align (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 Sunshine Health Dual Align (HMO D-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, copays start at $18 and $19 respectively for a one-month supply at preferred pharmacies, with no copay for three-month fills through preferred mail order. Tier 6 select care drugs also offer excellent savings with no copay for fills at preferred pharmacies or through preferred mail order. Brand-name and specialized medications under this plan utilize coinsurance or higher copays, such as a 25% coinsurance for Tier 3 preferred brands and Tier 5 specialty drugs. Tier 4 non-preferred drugs require a $100 copay for a one-month supply at both preferred and standard pharmacies. Reviewing these tier costs helps you determine your potential out-of-pocket expenses for your specific prescriptions.
Additional Benefits
The Wellcare Sunshine Health Dual Align (HMO D-SNP) plan offers comprehensive medical coverage, featuring an inpatient hospital copayment of $1,865 per admission and no coinsurance. For outpatient care, specialist visits, diagnostic services, and medical equipment, members generally pay no copay alongside a 20% coinsurance. Emergency room visits require a $115 copay, which is waived if you are admitted, while urgent care visits have a $40 copay. This plan also provides valuable supplemental benefits, including home health services and preventive and comprehensive dental care up to $3,000 annually with no copay or coinsurance. Members can access routine hearing and vision services with no copays and up to a 20% coinsurance, alongside allowances for hearing aids and eyewear. Additionally, the plan covers up to 36 one-way trips per year for plan-approved transportation and offers over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,865 copayment per admission and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under Wellcare Sunshine Health Dual Align (HMO D-SNP) are covered with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for most of these services, and there is no deductible for blood services.
Partial Hospitalization See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are also partially covered under prior authorization, providing up to 36 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance. Chiropractic services are partially covered with no copay or coinsurance for up to 12 routine visits per year, though other chiropractic services and podiatry services are not covered.
Preventive Services See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) provides preventive services with no copay and no coinsurance for annual physical exams, and no copay with a 20% coinsurance for kidney disease education and glaucoma screenings. Additional preventive services are partially covered with no copay and no coinsurance for fitness and alternative therapies, whereas health education, weight management, nutritional therapy, therapeutic massage, and counseling are not covered.
Hearing Services See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) hearing services are partially covered, featuring Medicare-covered exams and fitting evaluations with no copay and no coinsurance, alongside annual routine exams with a 20% coinsurance and no copay. Prescription hearing aids are covered up to $500 per ear each year with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) offers partially covered vision services, which exclude other eye exam services. Routine eye exams and eyewear (including lenses, frames, and upgrades) feature no copays and a 20% coinsurance for routine exams and contact lenses, with no deductibles and a combined annual eyewear maximum of $400.
Dental Services See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 20% coinsurance, and other preventive and comprehensive dental services with no copay and no coinsurance up to a $3,000 annual limit. Prior authorization is required for most services, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Sunshine Health Dual Align (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Sunshine Health Dual Align (HMO D-SNP) plan with no copay and a 20% coinsurance, and a referral is required.
Medical Equipment See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers medical equipment—including durable medical equipment, prosthetics, medical supplies, and diabetic equipment—with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers diagnostic and radiological services with no copay, though a 20% coinsurance, prior authorization, and referrals are required. Covered benefits include outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and X-rays.
Home Health Services See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no copay under the Wellcare Sunshine Health Dual Align (HMO D-SNP), but in practice only some services are covered because intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Sunshine Health Dual Align (HMO D-SNP) with no coinsurance, featuring no copay for days 1-20 and 71-100, and a $218 daily copay for days 21-70. Prior authorization and referrals are required, and while a prior three-day hospital stay is not required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Sunshine Health Dual Align (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan.
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