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Wellcare Delaware First Health Dual Align (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Delaware First Health 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 Delaware First Health Dual Align (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Delaware First Health 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 Statewide in DE. The overall rating for this plan is not yet available for 2026.
It's important to know that Wellcare Delaware First Health 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 Delaware First Health 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 Delaware First Health 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 Delaware First Health Dual Align (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.20. 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 $475.00 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 $9250.00 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 Delaware First Health Dual Align (HMO-POS D-SNP) plan features an annual prescription drug deductible of $475. For Tier 6 select care drugs, policyholders benefit from no copay across all pharmacy and mail-order options. Tier 1 preferred generics and Tier 2 generics offer low-cost copays starting at $18 and $19 respectively for a one-month supply, with no copay required for three-month supplies filled through preferred mail order. Higher-tier prescriptions transition to coinsurance or fixed copays depending on the medication classification. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 5 specialty drugs have a 25% coinsurance for a one-month supply. Tier 4 non-preferred drugs have a $100 copay for a one-month supply at both preferred and standard retail pharmacies.
Additional Benefits
The Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) plan offers comprehensive medical coverage, including inpatient hospital stays with no coinsurance and set copays of $2,200 for acute care or $2,080 for psychiatric care. For outpatient services, primary care, and specialist visits, members generally pay no copay and a 20% coinsurance. Emergency care is covered with a $115 copay, while urgent care has a $40 copay, both with no coinsurance. This plan also features robust supplemental benefits, offering home health services, routine physicals, and over-the-counter items with no copay and no coinsurance. Dental, vision, and hearing benefits are covered, featuring no copays and no coinsurance for routine eyewear up to $500, preventive and comprehensive dental up to $3,000, and hearing aids up to $2,000 per ear. Additionally, members can access up to 12 one-way transportation trips per year with no copay or coinsurance.
Inpatient Hospital See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,200 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and substance abuse services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance, which count toward the deductible and are waived if admitted within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) covers primary care, specialist, and therapy services with no copay and a 20% coinsurance, while podiatry services are covered with no copay and no coinsurance. Telehealth benefits are available with a $0 to $40 copay and 20% coinsurance, and although some chiropractic services are covered, routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Wellcare Delaware First Health Dual Align (HMO-POS D-SNP), including annual physical exams with no copay and no coinsurance, and kidney disease education or glaucoma screenings with no copay and a 20% coinsurance. Additional benefits are partially covered, offering fitness, alternative therapies, and remote access with no copay and no coinsurance, while health education, personal emergency response systems, and nutritional counseling are not covered.
Hearing Services See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) hearing services are partially covered, excluding OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids. Routine hearing exams require a 20% coinsurance and no copay, while fitting evaluations and covered prescription hearing aids are offered with no copay and no coinsurance up to a $2,000 annual maximum benefit per ear.
Vision Services See details
Vision services are partially covered by Wellcare Delaware First Health Dual Align (HMO-POS D-SNP), as other eye exam services are not covered. Routine eye exams are covered once per year with no copay and a 20% coinsurance, with no deductible. Covered eyewear has a $500 annual limit and no deductible, offering contact lenses with no copay and a 20% coinsurance, and eyeglasses, lenses, frames, and upgrades with no copay and no coinsurance.
Dental Services See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, alongside preventive and comprehensive services with no copay and no coinsurance up to a $3,000 annual limit. Prior authorization is required for these benefits, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance of 0% to 20%, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) plan with no copay and 20% coinsurance.
Medical Equipment See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) covers diagnostic and radiological services, including lab services, diagnostic procedures, therapeutic radiology, and X-rays, subject to prior authorization. There is no copay for these services, but a 20% coinsurance applies.
Home Health Services See details
Home Health Services are covered under the Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) with no copay, but only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) with no coinsurance, requiring no copay for days 1 through 20 and 71 through 100, and a $218 copay for days 21 through 70. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) partially covers other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required for the meal benefit.
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