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Wellcare 'Ohana Dual Align (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 'Ohana Dual Align (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare 'Ohana Dual Align (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Wellcare 'Ohana Dual Align (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in HI. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare 'Ohana Dual Align (HMO-POS 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 'Ohana Dual Align (HMO-POS 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 'Ohana Dual Align (HMO-POS 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 'Ohana Dual Align (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.10. 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 $590.00 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 $9350.00 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 'Ohana Dual Align (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After meeting your deductible, the plan covers prescription drugs, but the specific costs for each tier are not provided in this summary. Once your total drug costs reach $2000, you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly Part D premium will be $46.10. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a high copay, while outpatient services often involve 20% coinsurance. This plan also includes coverage for emergency services, primary care, preventive services, hearing, vision, and dental services. Many services have no copay, but some services require coinsurance, and there may be a limit on some benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan. For acute care, the copay is $2050 per admission or stay, and for psychiatric care, the copay is $2036 per admission or stay. Additional days, and non-medicare covered stays are not covered for either acute or psychiatric care.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a 20% coinsurance and no copay, while Observation Services have a 20% coinsurance. Outpatient Blood Services have a 20% coinsurance. Individual and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
Under the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan, Primary Care Physician Services and Chiropractic Services are covered, with a 20% coinsurance for the former and no copay for the latter. Occupational Therapy, Physician Specialist, Mental Health Specialty, Other Health Care Professional, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, and Additional Telehealth benefits are covered with a 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services may have a copay. Kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with a 20% coinsurance for routine hearing exams and no copay. Prescription hearing aids (all types) are covered with a $0 copay, while inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay, and eyewear. Eyewear has a 20% coinsurance, and a $100 maximum plan benefit coverage per year. Routine eye exams have no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental services are covered by the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan, with 20% coinsurance for Medicare dental services, while other diagnostic and preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral surgery have no copay. Oral exams, dental x-rays, prophylaxis, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum plan benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), is covered by this plan with a 20% coinsurance, with no copay. Prosthetic devices and medical supplies are covered with a 20% coinsurance and no copay. Diabetic equipment is covered, with a 20% coinsurance and no copay for diabetic supplies and diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan. For Diagnostic Procedures/Tests and Radiological Services, you may pay at most 20% coinsurance, while Lab Services have no copay and at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan. The plan does not cover any of the cardiac and pulmonary rehabilitation services, including intensive cardiac rehabilitation services, pulmonary rehabilitation services, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The Wellcare 'Ohana Dual Align (HMO-POS D-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 24 treatments per year. Over-the-counter items are also covered with no copay, including nicotine replacement therapy and naloxone.
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