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Wellcare CalViva Health Dual Align (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare CalViva 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 CalViva Health Dual Align (HMO D-SNP) in 2025, please refer to our full plan details page.
Wellcare CalViva Health 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 CA. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Wellcare CalViva 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 CalViva 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 CalViva 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 CalViva Health Dual Align (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.80. 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 $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 CalViva Health Dual Align (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs associated with the drug tiers, but these costs are not listed here. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. This plan's premium is $28.80 per month if you qualify for the low-income subsidy.
Additional Benefits
The Wellcare CalViva Health Dual Align (HMO D-SNP) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services often involve a 20% coinsurance. Emergency services have a copay, and ambulance services have a 20% coinsurance. Preventive services include an annual physical exam with no copay, and other services with a 20% coinsurance. The plan also covers hearing, vision, and dental services with no copays for some services, and a 20% coinsurance for others. Other services like home health and skilled nursing facilities have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $1,630 and $1,937 per stay, respectively. Additional days for Inpatient Hospital-Acute and Psychiatric, as well as non-Medicare-covered stays and upgrades, are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with no copay and 20% coinsurance, Observation Services with 20% coinsurance, Ambulatory Surgical Center (ASC) Services with 20% coinsurance, Outpatient Substance Abuse Services with 20% coinsurance, and Outpatient Blood Services with 20% coinsurance. Outpatient Blood Services also waives the three (3) pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance services are covered with no copay, but you are responsible for a 20% coinsurance for both ground and air ambulance services. Transportation Services to a Plan Approved Health-related Location are covered with no copay for up to 12 one-way trips per year. Transportation Services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the Wellcare CalViva Health Dual Align (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has a $45 copay; all three have no coinsurance. Worldwide Urgent Coverage has a $110 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Chiropractic Services, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Podiatry Services have a 20% coinsurance and no copay, and Additional Telehealth Benefits have a copay between $0-$45.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with a 20% coinsurance. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered. Fitness benefits, remote access technologies, and home and bathroom safety devices have no copay. Alternative therapies have no copay.
Hearing Services See details
Hearing services include hearing exams, with a coinsurance of at most 20% for routine hearing exams, and a no copay. Fitting/Evaluation for Hearing Aids has a no copay. Prescription hearing aids are covered with a maximum benefit of $350 per year, and a no copay for all types of prescription hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Wellcare CalViva Health Dual Align (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Eyewear has a combined maximum plan benefit coverage of $100. Contact lenses, eyeglass lenses, eyeglass frames, upgrades, and eyeglasses (lenses and frames) have no copay.
Dental Services See details
Dental services include coverage for Medicare Dental Services with 20% coinsurance, Restorative Services, Prosthodontics (removable), and Prosthodontics (fixed) with no copay, as well as Orthodontic Services. Adjunctive General Services, Endodontics, Periodontics, Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B insulin drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare CalViva Health Dual Align (HMO D-SNP) plan. You will pay 20% coinsurance for these services, and a doctor referral is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for Medicare-covered supplies, and therapeutic shoes or inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, and radiological services. Diagnostic procedures and tests have a coinsurance of at most 20%, while lab services have a coinsurance of at most 20% and no copay. Radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare CalViva Health Dual Align (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare CalViva Health Dual Align (HMO D-SNP) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by this plan, with prior authorization and a doctor's referral required. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other services offered by the Wellcare CalViva Health Dual Align (HMO D-SNP) plan include Over-the-Counter (OTC) Items with no copay, while acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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