2027 Medicare Advantage plan

Wellcare Superior HealthPlan Dual Align (HMO D-SNP): 2027 benefits and costs

Wellcare HMO D-SNP Special Needs Plan

CMS plan ID: H0062-012-0 · Plan year: 2027

Wellcare Superior HealthPlan Dual Align (HMO D-SNP) is a 2027 Medicare Advantage plan offered by Wellcare. It is listed in Texas.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$700.00

In-network medical out-of-pocket maximum$9,850.00

Costs shown are before Medicaid or Extra Help; your costs depend on your eligibility and assistance.

Organization: Wellcare
Plan organization: SUPERIOR HEALTHPLAN, INC.
Parent company: Centene Corporation
Plan type: HMO D-SNP
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
Special Needs Plan type: Dual-Eligible
2027 CMS Star Rating: Not enough data available

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
In-network medical maximum: $9,850.00

Who can join this Special Needs Plan?

This plan is for people who qualify for both Medicare and Medicaid. The plan must confirm the required Medicaid eligibility level. Your costs can depend on your assistance level.

Plan eligibility type: Dual-Eligible

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	20% coinsurance Service-specific deductible No
Specialist visit	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Telehealth	$0.00 to $40.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Emergency care	$115.00 copay
Urgent care	$40.00 copay
Home health	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Dialysis	15% coinsurance Service-specific deductible No	Approval required No Referral required Yes
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	20% coinsurance Service-specific deductible No	Approval required No Referral required Yes
Medicare-covered chiropractic	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Medicare-covered foot care	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Other health professionals	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$2,140.00 copay per stay	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay
Inpatient mental health care	$2,091.00 copay per stay	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–70: $221.00 copay per day Days 71–100: $0.00 copay per day	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	20% coinsurance Service-specific deductible No
Hospital observation services	20% coinsurance Service-specific deductible No
Ambulatory surgical center	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Outpatient blood	20% coinsurance Service-specific deductible No	Approval required No Referral required Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Laboratory services	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Diagnostic radiology (CT, MRI)	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Therapeutic radiology	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
X-rays	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Intensive outpatient program	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Substance use treatment, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Substance use treatment, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Opioid treatment program	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Cardiac rehabilitation	20% coinsurance Service-specific deductible No	Approval required No Referral required Yes
Intensive cardiac rehabilitation	20% coinsurance Service-specific deductible No	Approval required No Referral required Yes
Pulmonary rehabilitation	20% coinsurance Service-specific deductible No	Approval required No Referral required Yes
Supervised exercise for peripheral artery disease	20% coinsurance Service-specific deductible No	Approval required No Referral required Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Air ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Durable medical equipment	20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic monitors	20% coinsurance Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	20% coinsurance
Oral examsAdditional plan benefit	$0.00 copay
Dental X-raysAdditional plan benefit	$0.00 copay
Other diagnostic dentalAdditional plan benefit	$0.00 copay
Dental cleaningAdditional plan benefit	$0.00 copay
FluorideAdditional plan benefit	$0.00 copay
Other preventive dentalAdditional plan benefit	$0.00 copay
Restorative dental careAdditional plan benefit	$0.00 copay
Root canal treatment (endodontics)Additional plan benefit	$0.00 copay
Gum treatment (periodontics)Additional plan benefit	$0.00 copay
Removable dentures (prosthodontics)Additional plan benefit	$0.00 copay
Fixed dental restorations (prosthodontics)Additional plan benefit	$0.00 copay
Oral surgeryAdditional plan benefit	$0.00 copay
Other dental servicesAdditional plan benefit	$0.00 copay

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Routine eye examsAdditional plan benefit	$0.00 copay	Approval required Yes Referral required No
Medicare-covered eyewear	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Contact lensesAdditional plan benefit	$0.00 copay	Approval required Yes Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0.00 copay	Approval required Yes Referral required No
Eyeglass lensesAdditional plan benefit	$0.00 copay	Approval required Yes Referral required No
Eyeglass framesAdditional plan benefit	$0.00 copay	Approval required Yes Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Routine hearing examsAdditional plan benefit	$0.00 copay	Approval required Yes Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0.00 copay	Approval required Yes Referral required No
Prescription hearing aids (all types)Additional plan benefit	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Over-the-counter health itemsAdditional plan benefit	$0.00 copay Service-specific deductible No
Limited-duration mealsAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required Yes
Annual physical examAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

SSBCI OTC

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Over-the-counter health items; Additional Benefits for SSBCI
Service categories that apply to the combined supplemental benefits group for Special Supplemental Benefits for Chronically Ill (SSBCI) package(s): Food and produce (SSBCI: SSBCI OTC); Additional meal benefits (SSBCI: SSBCI OTC); Pest control (SSBCI: SSBCI OTC); Transportation for non-medical needs (SSBCI: SSBCI OTC); Social support benefit (SSBCI: SSBCI OTC); Support for daily living (SSBCI: SSBCI OTC)
How benefits are provided: Debit Card; Reimbursement
Advance choice of benefits required: No
Shared benefit limit: $172.00
How often this limit applies: Every one month
Are the benefits combined such that a single benefit maximum available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?: Yes
Shared limit on visits or trips: No

Benefits for qualifying members

SSBCI OTC

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Overweight, obesity, and metabolic syndrome; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Immunodeficiency and Immunosuppressive disorders; Conditions associated with cognitive impairment; Conditions with functional challenges; Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell; Conditions that require continued therapy services in order for individuals to maintain or retain functioning; Other 1
Qualifying conditions: Endometriosis
Included services: Food and produce; Additional meal benefits; Pest control; Transportation for non-medical needs; Social support benefit; Support for daily living
Some package benefits are exempt from the deductible: Yes
Services exempt from the deductible: Food and produce; Additional meal benefits; Pest control; Transportation for non-medical needs; Social support benefit; Support for daily living
Package limit: $0.00
How often this limit applies: Every month
How benefits are provided: Debit Card; Reimbursement
Services sharing the package limit: Food and produce; Additional meal benefits; Pest control; Transportation for non-medical needs; Social support benefit; Support for daily living

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2; Tier 4; Tier 6 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Generic	$0.00	$0.00	$0.00
Tier 2Preferred Brand	19%	19%	19%
Tier 3Non-Preferred Drug	38%	38%	38%
Tier 4Injectable Drugs	0%	0%	0%
Tier 5Specialty Tier	25%	Not listed	Not listed
Tier 6Select Care Drugs	$0.00	$0.00	$0.00

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Generic	$15.00	$30.00	$45.00
Tier 2Preferred Brand	25%	25%	25%
Tier 3Non-Preferred Drug	47%	47%	47%
Tier 4Injectable Drugs	15%	15%	15%
Tier 5Specialty Tier	25%	Not listed	Not listed
Tier 6Select Care Drugs	$0.00	$0.00	$0.00

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Preferred mail order costs

Preferred mail order: initial-coverage cost per prescription fill
Drug tier	60 days	100 days
Tier 1Generic	$0.00	$0.00
Tier 2Preferred Brand	19%	19%
Tier 3Non-Preferred Drug	38%	38%
Tier 4Injectable Drugs	0%	0%
Tier 6Select Care Drugs	$0.00	$0.00

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier	60 days	100 days
Tier 1Generic	$30.00	$45.00
Tier 2Preferred Brand	25%	25%
Tier 3Non-Preferred Drug	47%	47%
Tier 4Injectable Drugs	15%	15%
Tier 6Select Care Drugs	$0.00	$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Generic	$15.00
Tier 2Preferred Brand	25%
Tier 3Non-Preferred Drug	47%
Tier 4Injectable Drugs	15%
Tier 5Specialty Tier	25%
Tier 6Select Care Drugs	$0.00

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Generic	$15.00
Tier 2Preferred Brand	25%
Tier 3Non-Preferred Drug	47%
Tier 4Injectable Drugs	15%
Tier 5Specialty Tier	25%
Tier 6Select Care Drugs	$0.00

Drug coverage rules and exceptions

Tier 1: Generic

Drugs included in this tier: Both Part D and Excluded Drugs
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Injectable Drugs

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Tier 6: Select Care Drugs

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

Texas

Hidalgo, Texas