Wellcare CalViva Health Dual Align (D-SNP) H3561 007 0 Plan Details
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*CMS rated this Wellcare plan (H3561-007-0) 2.5 (Below Average) out of 5 stars.
Wellcare CalViva Health Dual Align (D-SNP) is a Dual-Eligible Medicare Special Needs Plan. The 2025 Annual Enrollment period starts October 15. Plan benefits begin January 1.
The delivery of healthcare services and costs by Wellcare is different than Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Only individuals who meet all Dual-Eligible SNP qualification requirements are eligible to join this D-SNP plan.
| Plan Basics | |
|---|---|
| Plan ID: | H3561-007-0 |
| Plan Type: | HMO D-SNP |
| Plan Year: | 2025 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | 9,350.00 /yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Basic $590.00 deductible |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | See List |
| Insured By: | Wellcare |
| Summary of Benefits |
|---|
Health Plan Cost Sharing & Benefits
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Wellcare plan:
Doctor's Office Visits
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $0 Copay Prior Authorization Required, Referral Required |
Emergency, Urgent, and Inpatient Hospital Coverage
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $0 Copay |
| Urgent care: | $0 Copay |
| Ground ambulance: | $0 Copay |
| Inpatient hospital care: | $1,630.00 per stay |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 and beyond |
Foot Care
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $0 Copay Prior Authorization Required, Referral Required |
| Routine Foot Care: | $0 Copay Prior Authorization Required, Referral Required |
Chiropractic Care
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $0 Copay Prior Authorization Required, Referral Required |
| Routine chiropractic: | $0 Copay Prior Authorization Required, Referral Required |
Mental Health Services
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $0 Copay |
| Outpatient group therapy: | $0 Copay |
| Inpatient psychiatric hospital care: | $1,937.00 per stay |
Rehabilitation Services
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $0 Copay Prior Authorization Required, Referral Required |
| Occupational therapy: | $0 Copay Prior Authorization Required, Referral Required |
Medical Equipment and Supplies
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | $0 Copay Prior Authorization Required |
| Prosthetics: | $0 Copay |
Diagnostics, Lab Services, and Imaging
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $0 Copay Prior Authorization Required, Referral Required |
| Lab services: | $0 Copay Prior Authorization Required, Referral Required |
| Outpatient x-rays: | $0 Copay Prior Authorization Required, Referral Required |
| Diagnostic tests and procedures: | $0 Copay Prior Authorization Required, Referral Required |
Medicare Part B Drugs
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | $0 Copay |
| Other Part B drugs (Medicare-covered): | $0 Copay |
Dental Services
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | 20% Coinsurance Prior Authorization Required |
| Oral exam | Not Covered |
| Dental x-rays | Not Covered |
| Cleaning | Not Covered |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
Hearing Aids and Services
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Vision Services
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | 20% Coinsurance |
| Routine eye exam (in-network) | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: No Contact Lenses: No Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $2.00 Every three years |
Feel free to download our Wellcare CalViva Health Dual Align Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
Wellcare CalViva Health Dual Align includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. LIS, also known as Extra Help, is a Social Security program that helps people with limited income and resources lower or cut Part D costs.
The following table outlines the premium details of this prescription drug plan.
| Basic Part D Premium: | $28.80 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $28.80 |
| Low Income Premium Subsidy: | $29.66 |
| Low Income Premium Subsidy CMS Pays: | $28.80 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Wellcare begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Wellcare CalViva Health Dual Align has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order | Out of Network |
|---|---|---|---|
| Cost data not available. | |||
| *The Part D deductible does not apply. | |||
CMS 5-Star Rating Marks
Each year CMS rates Medicare Special Needs Plans in nine broad categories based on a 5-star system. The table below shows the quality ratings for this Wellcare plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Plan Availability
Wellcare CalViva Health Dual Align (H3561-007-0) is available in the following locations (click to open):
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- H3561-009-0: Wellcare Dual Liberty ()
- H3561-001-0: Wellcare Dual Liberty ()
- H3561-007-0: Wellcare CalViva Health Dual Align ()
- H3561-008-0: Wellcare Dual Align ()
Contact Wellcare
| Website: | Wellcare Plan Page |
|---|---|
| Providers: | Wellcare Providers Page |
| Formulary: | Wellcare Formulary Page |
| Pharmacy: | Wellcare Pharmacy Page |
| New Member Health Plan Help: | (800)225-8017 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)270-5320 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- Wellcare, http://www.wellcare.com/healthnetCA, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in California", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.