Wellcare Buckeye MyCare Ohio Dual Align Unity (HMO D-SNP) Medicare Special Need Plan H4158-001 • 2027
- 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
- See List
- Total Enrollment
- 7,256 beneficiaries
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 across the plan's service areas totals 7,256 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.
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.
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.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Specialist | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Lab services | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Outpatient x-rays | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Diagnostic tests and procedures | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $0 copay | $0 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | $0 copay | $0 copay |
| Inpatient hospital care | Tier 1 $0 per stay |
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 |
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 | In-network: $0 copay Out-of-network: $0 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Outpatient group therapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Inpatient psychiatric hospital care | Tier 1 $0 per stay |
Tier 1 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Occupational therapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Durable medical equipment | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Prosthetics | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Other Part B drugs (Medicare-covered) | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | Not covered | In-network: $0 copay |
| Dental x-rays | Not covered | In-network: $0 copay |
| Cleaning | Not covered | Not covered |
| Periodontics | Not covered | In-network: $0 copay |
| Endodontics | Not covered | In-network: $0 copay |
| Restorative services | Not covered | In-network: $0 copay |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | Not covered | In-network: $0 copay |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | Not covered | In-network: $0 copay |
| Contact lenses | Not covered | In-network: $0 copay |
| Eyeglass frames only | Not covered | In-network: $0 copay |
| Eyeglass lenses only | Not covered | In-network: $0 copay |
| Eyeglasses (frames & lenses) | Not covered | In-network: $0 copay |
| Upgrades | Not covered | In-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | Not covered | In-network: $0 copay |
| Fitting/evaluation | Not covered | In-network: $0 copay |
| Prescription hearing aids | Not covered | In-network: $0 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | In-network: $0 copay | In-network: $0 copay |
| Personal emergency response system | Coming soon | In-network: $0 copay |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | In-network: $0 copay | In-network: $0 copay |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | 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.
| 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.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Generic | $0.00 copay | $19.00 copay |
| Preferred Brand | 20% coinsurance | 25% coinsurance |
| Non-Preferred Drug | 42% coinsurance | $100.00 copay |
| Injectable Drugs | 0% coinsurance | Not available |
| Specialty Tier | 25% coinsurance | 25% coinsurance |
| Select Care Drugs | $0.00 copay | $0.00 copay |
| Preferred Generic | Not 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.
| 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 |
Contact Information for Wellcare
- Website
- Wellcare Plan Page
- Providers
- Wellcare Providers Page
- Formulary
- Wellcare Formulary Page
- Pharmacy
- Wellcare Pharmacy Page
- New Member Health Plan Help
- (844)480-0680
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)480-0680
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Wellcare Buckeye MyCare Ohio Dual Align Unity (H4158-001-0) is available in the following locations (click to open):
Medicare Plan Data Sources and Methodology
| 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.
| 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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