Wellcare Health Net Dual Align (HMO D-SNP)

Wellcare Health Net 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 Health Net 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 Health Net 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 Health Net Dual Align (HMO D-SNP) prescription drug plan features a $555.00 deductible before the initial coverage phase begins. Once the deductible is met, you will pay a $19.00 copay at preferred pharmacies or a $20.00 copay at standard pharmacies for Tier 1 preferred generic drugs. For other tiers, cost-sharing includes a 20% coinsurance for standard generics, 32% coinsurance for preferred brands, 25% coinsurance for non-preferred drugs, and no copay for specialty tier drugs. These initial coverage rates apply until your total yearly drug costs reach $2,100.00. After reaching this $2,100.00 out-of-pocket threshold, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescription drugs. Additionally, individuals who qualify for the low-income subsidy may see their Part D premium reduced to $12.00.

Additional Benefits

The Wellcare Health Net Dual Align (HMO D-SNP) plan covers a wide range of medical services, typically requiring no copay and a 20% coinsurance for outpatient care, primary care visits, and medical equipment. For acute care, members face a $1,680 copay per admission for inpatient hospital stays and a $115 copay for emergency room visits, both with no coinsurance. Skilled nursing facility care is also covered with no copay for days 1 to 20, shifting to a $218 daily copay for days 21 to 70. In addition to medical care, the plan offers no copay and no coinsurance for home health services and over-the-counter health items. Vision, dental, and hearing benefits are partially covered, providing eyeglasses and prescription hearing aids up to annual limits with no copay. However, routine eye and hearing exams, along with standard Medicare dental services, require a 20% coinsurance and no copay.