Wellcare CalViva Health Dual Align (HMO D-SNP)

California Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)


Monthly Premium

Your Cost
$0
by Wellcare by Health Net

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 2.5
out of 5 stars

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Plan Name
Wellcare CalViva Health Dual Align (HMO D-SNP)
Insurance Carrier
Wellcare by Health Net
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

Wellcare CalViva Health Dual Align (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in California and offered by the health insurance company Wellcare by Health Net. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$9,350
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

Wellcare CalViva Health Dual Align (HMO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $9,350 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Wellcare CalViva Health Dual Align (HMO D-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Wellcare CalViva Health Dual Align (HMO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Wellcare CalViva Health Dual Align (HMO D-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Wellcare CalViva Health Dual Align (HMO D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Limited coverage
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Wellcare CalViva Health Dual Align (HMO D-SNP) received an overall government quality rating of 2.5 stars out of 5 stars.

Wellcare CalViva Health Dual Align (HMO D-SNP) performed worse than California’s State average overall quality score of 2.8 stars.

This Plan’s 5-star Gov’t Quality Score
California State Average Score
Overall Government 5 Star Quality Rating
 2.5
 2.8
Summary rating of health plan quality
 2.5
 2.8
Staying healthy: screenings, tests, & vaccines
 3
 3.5
Managing chronic (long term) conditions
 3
 3.2
Member experience with health plan
(coming soon)
 1.6
Member complaints & changes in the health plan's performance
 1
 3.2
Health plan customer service
(coming soon)
 3.8
Summary rating of drug plan quality
 2.5
 3.0
Drug plan customer service
 4
 4.3
Member complaints & changes in the drug plan's performance
 2
 3.4
Member experience with the drug plan
(coming soon)
 2.8
Drug safety & accuracy of drug pricing
 3
 3.2

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Wellcare CalViva Health Dual Align (HMO D-SNP) received 2.5 stars for its health plan quality score which is worse than the California State average health plan quality score of 2.8 stars.

Wellcare CalViva Health Dual Align (HMO D-SNP) received 2.5 stars for its drug plan quality score which is worse than the California State average drug plan quality score of 3.0 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$9,350 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$0 copay

Tests, labs, & imaging

Diagnostic tests & procedures
$0 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$0 copay
Outpatient x-rays
$0 copay
Emergency care
$0 copay
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
$0 copay
Outpatient hospital coverage
$0 copay

Skilled nursing facility

Skilled nursing facility
$0 copay

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$0 copay

Therapy services

Occupational therapy visit
$0 copay
Physical therapy & speech & language therapy visit
$0 copay

Mental health services

Outpatient group therapy with a psychiatrist
$0 copay
Outpatient individual therapy with a psychiatrist
$0 copay
Outpatient group therapy visit
$0 copay
Outpatient individual therapy visit
$0 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
$0 copay
Prosthetics (like braces, artificial limbs)
$0 copay
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25% coinsurance

Brand-name drugs :
25% coinsurance


Generic drugs :
0% coinsurance

Brand-name drugs :
0% coinsurance

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
$0 copay
Other Part B drugs
$0 copay

Hearing

Hearing exam
$0 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$0 copay

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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