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Wellcare Dual Align (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Dual Align (HMO D-SNP) in 2025, please refer to our full plan details page.
Wellcare 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 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 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 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 Dual Align (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.60. 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 Dual Align (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs. Once your total drug costs reach $2,000, you enter the Catastrophic Coverage phase. During this phase, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Wellcare Dual Align (HMO D-SNP) plan provides comprehensive coverage, including inpatient hospital stays with a high copay, and outpatient services with coinsurance. This plan offers a variety of benefits, such as hearing and vision services, and dental services, with varying cost-sharing amounts. You'll also find coverage for emergency services, preventive services, and home health services with no copay, as well as transportation benefits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a copay of $1,790 and $1,937 per admission or stay, respectively. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric inpatient hospital services 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 a 20% coinsurance, Outpatient Substance Abuse Services with a 20% coinsurance, and Outpatient Blood Services with 20% coinsurance. Outpatient Blood Services includes an enhanced benefit where the three-pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Align (HMO D-SNP) plan, but requires prior authorization and a doctor's referral. You will be responsible for a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellcare Dual Align (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and Transportation Services have no copay, covering 12 one-way trips per year to plan-approved health-related locations via rideshare, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered under the Wellcare Dual Align (HMO D-SNP) plan with a copay of $110 and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Align (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services, with a 20% coinsurance for most services. Chiropractic services require prior authorization, and routine chiropractic care is not covered. Additional telehealth benefits have a copay between $0 and $45.
Preventive Services See details
The Wellcare Dual Align (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include alternative therapies, fitness benefits, remote access technologies, and home and bathroom safety devices with no copay. Other services like glaucoma screening, diabetes self-management training, and barium enemas have a 20% coinsurance.
Hearing Services See details
Wellcare Dual Align (HMO D-SNP) covers hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids with no copay, but prescription hearing aids are covered with no copay, and a maximum benefit of $1,000 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Eye exams have no copay and a 20% coinsurance, while routine eye exams have no copay. Eyewear has a 20% coinsurance, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The Wellcare Dual Align (HMO D-SNP) plan covers Medicare Dental Services with 20% coinsurance, Restorative Services, Prosthodontics (removable and fixed) with no copay, but 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 by the Wellcare Dual Align (HMO D-SNP) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Align (HMO D-SNP) plan with a doctor referral required, and a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance for Medicare-covered items, and Diabetic Supplies and Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Wellcare Dual Align (HMO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 20%, and lab services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Wellcare Dual Align (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Dual Align (HMO D-SNP) plan. This includes 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 Dual Align (HMO D-SNP) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay; however, 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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