Wellcare CalViva Health Dual Align (HMO D-SNP)

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 3.5 out of 5 stars in 2026.

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.

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.

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:

Drug Coverage

The Wellcare CalViva Health Dual Align (HMO D-SNP) plan features a $555.00 prescription drug deductible, which may be reduced to $12.00 for individuals who qualify for the low-income subsidy. During the initial coverage phase, Tier 1 preferred generic drugs require a $19.00 copay at preferred pharmacies or a $20.00 copay at standard pharmacies. Other tiers carry a coinsurance between 20% and 32%, though Tier 5 specialty drugs require no copay. These initial copays and coinsurance rates apply until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug expenses reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. This plan structure provides clear cost stages to help you manage your prescription medication expenses.

Additional Benefits

The Wellcare CalViva Health Dual Align (HMO D-SNP) plan covers essential medical services, though many require prior authorization and referrals. For inpatient hospital stays, members pay a $1,995 copay per stay with no coinsurance, while emergency room visits carry a $115 copay. Most outpatient services, primary care visits, diagnostics, and medical equipment feature no copay and a 20% coinsurance. Preventive care and home health services are available with no copay and no coinsurance, but routine dental, vision, and hearing benefits are not covered. Skilled nursing facility stays require no copay for the first 20 days, but a $218 daily copay applies for days 21 through 70. Additionally, this plan does not cover cardiac rehabilitation, over-the-counter items, or meal benefits.