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Wellcare Buckeye MyCare Ohio Dual Align Unity (HMO D-SNP) H4158-001 • 2027 • Mahoning County, OH

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$9850.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Mahoning County, OH
Local Enrollment
0 beneficiaries in Mahoning County
Last update:

Introduction

CMS Plan ID H4158-001 identifies Wellcare Buckeye MyCare Ohio Dual Align Unity, a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Wellcare. Its provider network is a Health Maintenance Organization (HMO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $0.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.

Enrollment in this plan requires you to live in Mahoning County, Ohio. CMS reports 0 beneficiaries enrolled in this plan in Mahoning County. New members can call the plan directly at (844)480-0680 (TTY 711) for assistance.

Eligibility

Wellcare Buckeye MyCare Ohio Dual Align Unity is a Medicare D-SNP plan for people who qualify for both Medicare and Medicaid.

Special Needs Plan Type
Dual-Eligible Special Needs Plan (D-SNP)
Medicare Requirement
Medicare Part A and Part B
Special Needs Requirement
Must qualify for Medicaid
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Compare Similar Plans in Mahoning County

Compare this plan with the two most-enrolled HMO D-SNP plans available in Mahoning County, Ohio. Enrollment is based on CMS local enrollment data.

HMO D-SNP plan comparison for Mahoning County, Ohio
Plan Detail Wellcare Buckeye MyCare Ohio Dual Align Unity CareSource MyCare Ohio Anthem I MyCare Ohio Full Dual Support
CMS Plan ID H4158-001-0 H6396-017-0 H2628-001-0
Local Enrollment 0 2,375 658
Monthly Premium $0.00 $21.10 $0.00
Medical Deductible $0.00 $0.00 $0.00
Maximum Out-of-Pocket $9,850.00 $9,650.00 $9,850.00
Part B Giveback Not offered Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist $0 copay $0 copay $0 copay
Part D Deductible $700.00 $700.00 $105.00
CMS Star Rating Not yet rated Not yet rated Not yet rated
Dental Not covered $0 copay $0 copay
Vision Not covered $0 copay $0 copay
Hearing Not covered $0 copay $0 copay

Plan Benefits

Wellcare Buckeye MyCare Ohio Dual Align Unity has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H4158-001.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H4158-001-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $0 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Telehealth benefit
In-network: $0 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $0 copay
Lab services
In-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Diagnostic tests and procedures
In-network: $0 copay

Emergency and Urgent Care Services

Emergency room care
$0 copay
Worldwide emergency care
Coming soon
Urgent care
$0 copay
Inpatient hospital care
Tier 1
$0 per stay
Skilled Nursing Facility
Tier 1
$0 per day for days 1-20
$0 per day for days 21-70
$0 per day for days 71-100
Ground ambulance
In-network: $0 copay

Mental Health Services

Outpatient individual therapy
In-network: $0 copay
Outpatient group therapy
In-network: $0 copay
Inpatient psychiatric hospital care
Tier 1
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $0 copay
Occupational therapy
In-network: $0 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Durable medical equipment
In-network: $0 copay
Prosthetics
In-network: $0 copay

Medicare Part B Drugs

Chemotherapy
In-network: $0 copay
Other Part B drugs (Medicare-covered)
In-network: $0 copay

Dental Services

Oral exam
Not covered
Dental x-rays
Not covered
Cleaning
Not covered
Periodontics
Not covered
Endodontics
Not covered
Restorative services
Not covered
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
Not covered

Vision Services

Routine eye exam
Not covered
Contact lenses
Not covered
Eyeglass frames only
Not covered
Eyeglass lenses only
Not covered
Eyeglasses (frames & lenses)
Not covered
Upgrades
Not covered

Hearing Services

Hearing exam
Not covered
Fitting/evaluation
Not covered
Prescription hearing aids
Not covered
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
In-network: $0 copay
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
In-network: $0 copay
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Wellcare Buckeye MyCare Ohio Dual Align Unity as a Part B benefit.

Prescription Drug Coverage

Wellcare Buckeye MyCare Ohio Dual Align Unity includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

Wellcare Buckeye MyCare Ohio Dual Align Unity (H4158-001-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($31.30)
Supplemental Part D Premium:$31.30
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$21.05
Low-Income Premium Subsidy Paid by CMS:$0.00
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Wellcare starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Wellcare Buckeye MyCare Ohio Dual Align Unity may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Wellcare Buckeye MyCare Ohio Dual Align Unity (H4158-001-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Generic$0.00 copay$19.00 copay
Preferred Brand20% coinsurance25% coinsurance
Non-Preferred Drug42% coinsurance$100.00 copay
Injectable Drugs0% coinsuranceNot available
Specialty Tier25% coinsurance25% coinsurance
Select Care Drugs$0.00 copay$0.00 copay
Preferred GenericNot available$0.00 copay
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H4158)

Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.

2027 Medicare Star Ratings for Contract H4158
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Plan too new to be measured
Managing Chronic (Long Term) Conditions Plan too new to be measured
Member Experience with Health Plan Plan too new to be measured
Complaints and Changes in Plans Performance Plan too new to be measured
Health Plan Customer Service Plan too new to be measured
Drug Plan Customer Service Plan too new to be measured
Complaints and Changes in the Drug Plan Plan too new to be measured
Member Experience with the Drug Plan Plan too new to be measured
Drug Safety and Accuracy of Drug Pricing Plan too new to be measured
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Wellcare (official source) http://go.wellcare.com/BuckeyeOH October 4, 2026
CMS.gov Dual Eligible Special Needs Plans (D-SNPs) April 28, 2026
Medicare.gov Understanding Medicare Advantage Plans April 28, 2026
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You April 28, 2026

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.