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.
Below are a few key facts and commonly-asked questions about Wellcare Sunshine Health Dual Align (HMO D-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
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.
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The Wellcare Sunshine Health Dual Align (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, you can expect a $1 copay for a 1-month supply at preferred pharmacies, or no copay for a 3-month supply using preferred mail order. Additionally, Tier 6 select care drugs are fully covered with no copay across all pharmacy and mail-order options. For Tier 2 generic drugs, the plan has a $19 copay for a 1-month supply at preferred pharmacies, while Tier 3 preferred brand drugs require a 20% coinsurance. Tier 4 non-preferred drugs carry a $100 copay for a 1-month supply at both preferred and standard pharmacies. Finally, Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply at both preferred and standard pharmacies.
The Wellcare Sunshine Health Dual Align (HMO D-SNP) offers comprehensive medical coverage with no copay for primary care visits, home health services, and select preventive care. However, specialist visits, outpatient hospital services, and diagnostic tests require a 20% coinsurance with no copay. For acute needs, emergency room visits carry a $115 copay, urgent care has a $40 copay, and inpatient acute hospital stays require a $2,230 copay per admission. This plan also features supplemental benefits, including up to 36 one-way transportation trips per year and preventive dental care with no copay or coinsurance. Additionally, members receive no-copay allowances of up to $1,500 per ear annually for prescription hearing aids and $400 yearly for eyewear. Many specialized services, including durable medical equipment, dialysis, and Medicare-covered dental care, require prior authorization and carry a 20% coinsurance.
Wellcare Sunshine Health Dual Align (HMO D-SNP) partially covers inpatient hospital services, excluding upgrades, additional days, and non-Medicare-covered stays. Covered acute stays require a $2,230 copay per admission with no coinsurance, while covered psychiatric stays require a $2,080 copay per admission with no coinsurance.
Outpatient services are covered under the Wellcare Sunshine Health Dual Align (HMO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for most of these outpatient services.
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 this covered benefit.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgent care with a $40 copay and no coinsurance, with both copays waived if admitted within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum benefit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary care benefits under the Wellcare Sunshine Health Dual Align (HMO D-SNP) plan feature no copay and no coinsurance for primary care provider visits, while podiatry is not covered and chiropractic care is partially covered, excluding non-routine services. Other covered services, including specialists, mental health, and physical therapy, require no copay and a 20% coinsurance, while telehealth benefits carry a $0 to $40 copay and 20% coinsurance.
Wellcare Sunshine Health Dual Align (HMO D-SNP) partially covers preventive services, offering annual physical exams and select supplemental benefits like fitness and remote access technologies with no copay and no coinsurance. Other covered services, such as kidney disease education and glaucoma screenings, require a referral and have no copay but a 20% coinsurance, while several sub-services like health education and nutritional benefits are not covered.
Hearing services under the Wellcare Sunshine Health Dual Align (HMO D-SNP) are partially covered with no deductible, featuring annual routine exams and fitting evaluations for no copay, though routine exams require a 20% coinsurance. Prescription hearing aids are covered up to $1,500 per ear annually with no copay or coinsurance, while over-the-counter (OTC) hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers vision services with prior authorization, offering one annual routine eye exam with no copay and 20% coinsurance, while other eye exam services are not covered. Eyewear is covered up to a $400 yearly limit with no copay, featuring no coinsurance for eyeglasses, frames, and upgrades, and a 20% coinsurance for contact lenses.
Dental services are partially covered by Wellcare Sunshine Health Dual Align (HMO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental services. Most preventive and comprehensive dental benefits have no copay and no coinsurance, though prior authorization is required, and maxillofacial prosthetics and orthodontics are not covered.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services are covered under the Wellcare Sunshine Health Dual Align (HMO D-SNP) plan with no copay and a 20% coinsurance, though a referral is required to receive care.
Medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, is covered by Wellcare Sunshine Health Dual Align (HMO D-SNP) 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 are covered by Wellcare Sunshine Health Dual Align (HMO D-SNP) with no copay and a 20% coinsurance. These services, which include lab tests, diagnostic procedures, therapeutic radiological services, and outpatient X-rays, require prior authorization and referrals.
Home Health Services are covered by Wellcare Sunshine Health Dual Align (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance and no copay.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring no copay for days 1 to 20 and days 71 to 100, and a $218 daily copay for days 21 to 70. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services are partially covered by Wellcare Sunshine Health Dual Align (HMO D-SNP), offering over-the-counter items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture and other extra services in this category are not covered.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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