Wellcare CalViva Health Dual Align (HMO D-SNP)
Wellcare · HMO D-SNP · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $9,850
- Drug deductible
- $700
- Medicare star rating
- No rating yet
This is a special needs plan. Only some people can join: Dual-Eligible.
In plain English
Compared with the 3 other plans in Madera County that the same person could join.
What stands out
- No monthly premium
Watch out for
- No dental extra, though most plans here have one
- No hearing extra, though most plans here have one
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.Not counted, because the plan charges a percentage: Primary care visit, Lab tests.
- A busier year$40$0 in premiums + $40 for careTied for highest here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Not counted, because the plan charges a percentage: Primary care visit, Specialist visit, Lab tests, X-rays.
- A hard year$1,695$0 in premiums + $1,695 for careHigher than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Not counted, because the plan charges a percentage: Primary care visit, Specialist visit, Lab tests, MRI, CT and other scans, Ground ambulance.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit20%
- Specialist visit20%Referral neededPlan approval may be needed
- Urgent care$40
- Emergency room$115Not charged if you stay in the hospital within 24 hours
- Hospital stay$1,580 per stayReferral neededPlan approval may be needed
- Lab tests20%Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center20%Referral neededPlan approval may be needed
- Outpatient hospital care20%
- X-rays20%Referral neededPlan approval may be needed
- MRI, CT and other scans20%Referral neededPlan approval may be needed
- Ground ambulance20%Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $221 a day for days 21 to 70, then $0 for days 71 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 3 other plans in Madera County that the same person could join. Read the plan’s 2027 booklet (PDF)
What medicines cost
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Generic | $0 | $15 |
| 2Preferred BrandAfter the deductible | 25% of the price | 25% of the price |
| 3Non-Preferred DrugAfter the deductible | 29% of the price | 29% of the price |
| 4Injectable DrugsAfter the deductible | 25% of the price | 25% of the price |
| 5Specialty TierAfter the deductible | 25% of the price | 25% of the price |
| 6Select Care Drugs | $0 | $0 |
For a 1-month supply. The $700 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2027, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental Not included
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $100 a year.
- Hearing Not included
- Over-the-counter items IncludedUp to $15 a month for things like vitamins, pain relief and bandages.
- Fitness Not included
- Rides to care Not included
What changed from 2026
- Monthly premium2026$12 a month2027$0 a month
- Most you pay in a year2026$9,2502027$9,850
- Drug deductible2026$5552027$700
- Hospital stay2026$1,995 per stay2027$1,580 per stay
- Skilled nursing facility2026$0 for days 1 to 20, then $218 a day for days 21 to 70, then $0 for days 71 to 1002027$0 for days 1 to 20, then $221 a day for days 21 to 70, then $0 for days 71 to 100
- Vision2026Not covered2027Yearly eye exam: $0. Glasses or contacts covered. Eyewear: plan pays up to $100 a year
- Over-the-counter items2026Not covered2027Up to $15 a month for things like vitamins, pain relief and bandages
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Wellcare CalViva Health Dual Align (HMO D-SNP), plan number H3561-007, for 2027?”