Medicare Advantage · D-SNP · HMOPOS · 2027

Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP)

Wellcare H1032-2024.0 CMS rating for 2027

Is it offered where you live?

At a glance: $0 monthly premium and $0 primary care visits.

Eligibility required for this D-SNP. You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. See who can enroll

Monthly premium: $0; Part B premium separate
Yearly limit: $3,000; Most you’d pay for in-network care
Dental: $5,000/yr; Comprehensive dental allowance
Doctor visits: $0; Primary care · specialists $0

Check this plan for you

Referral needed to see a specialist

Add your doctors and prescriptions to see how they work with this plan.

Your doctors

Not checked yetSee if they’re in this plan’s network

Your prescriptions

Not checked yetSee your drug tier and monthly cost

Extra benefits

7 includedDental · Hearing · OTC allowance · Vision · Fitness · Transportation · Meals

Enter your ZIP code to see how you can enroll

Enrollment options depend on where you live. Enter your ZIP code so we can show the right ways to enroll in this plan.

Who can enroll

Eligibility for this Special Needs Plan

Eligibility required for this D-SNP

You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.

Integration status: CO
Some partial-dual categories accepted: Verify the exact Medicaid levels in the official plan documents.

Common dual-eligibility labels

These definitions are educational. They do not confirm which Medicaid categories this specific plan accepts.

FBDE: Full Medicaid benefits in addition to Medicare.
QMB+: QMB help with Medicare costs plus full Medicaid benefits.
SLMB+: SLMB help with the Part B premium plus full Medicaid benefits.
QMB: Help with Medicare premiums and Medicare-covered cost sharing.

Check the Summary of Benefits or Evidence of Coverage for the exact Medicaid levels this plan accepts.

Could a Medicare Savings Program help?

Medicare Savings Programs are run by each state. The 2026 federal baseline monthly income limits are:

QMB: $1,350 for one person or $1,824 for a married couple
SLMB: $1,616 for one person or $2,184 for a married couple
QI: $1,816 for one person or $2,455 for a married couple

Alaska, Hawaii, and some states use different limits or resource rules. Qualifying for an MSP does not by itself confirm eligibility for this D-SNP. Apply through your state Medicaid office.

Learn about QMB, SLMB, and QI

Extra benefits for members who qualify

Food and produce benefit
Meal benefit
Non-medical transportation benefit
General supports for living
Pest control service
Social needs benefit

These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.

Costs and copays

Deductibles, yearly limit, visits, hospital stays and drug tiers

DeductiblesMedical · $700 for drugs: $0
Yearly limitIn-network care, not counting drugs: $3,000
Primary doctorPer visit: $0
SpecialistPer visit · referral needed: $0
Hospital stayPer stay: Days 1-90: $0/day
Inpatient mental healthHospital stay: Days 1-90: $0/day
Outpatient surgeryPer procedure: $0–$225
Emergency roomPer visit: $150
Urgent carePer visit: $0
Tier 1 · Preferred Generic30-day supply at a retail pharmacy: $0
Tier 2 · Generic30-day supply at a retail pharmacy: 20%
Tier 3 · Preferred Brand30-day supply at a retail pharmacy, after deductible: 42%
Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy, after deductible: 0%
Tier 5 · Specialty30-day supply at a retail pharmacy, after deductible: 25%
Tier 6 · Drugs30-day supply at a retail pharmacy, after deductible: $0

This plan is for people with Medicaid. What you pay depends on your Medicaid level: with QMB, your share of Medicare-covered services is covered; with full Medicaid benefits, your state may also cover Medicaid-covered services. Your state Medicaid office can confirm your level — or call us at 1-866-764-3312 (TTY 711) and a Licensed Medicare Advisor will help confirm it and discuss this plan's details with you. If you lose Medicaid eligibility, you may be billed the plan's cost sharing.

Our take

Where this plan shines, and what to know

Where this plan shines

This plan has a $0 monthly premium.
This plan’s out-of-pocket maximum ($3,000) is among the lowest available.
See your primary doctor for $0.
The specialist copay ($0) is among the more affordable options.
No separate medical deductible.
Highly rated by CMS (4 stars).
Some out-of-network care is covered (HMO-POS).

Things to know before you enroll

Limited coverage while traveling outside the plan’s service area.

Similar plans

Other Medicare Advantage plans offered in Florida

Browse the full 2027 Dual Eligible Special Needs Plan directory. This plan is offered in Florida. Plan availability can vary by county.

More Dual Eligible Special Needs Plan options

These plans are offered in at least one of the same states. Check your ZIP or county before choosing a plan.

Common questions

6 answers about this plan

What does Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS) cover?

Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS) is a Dual Eligible Special Needs Plan, a Medicare Advantage plan for people who have Medicare and a Medicaid category the plan accepts. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 6 formulary tiers. Published supplemental benefits include dental ($5,000/yr comprehensive dental allowance), vision ($400/yr eyewear allowance), hearing ($1,000/yr hearing aid allowance), and over-the-counter (OTC) ($67/month OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS) cost in 2027?

The published 2027 monthly plan premium for Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS) is $0. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $0. The listed Part D deductible is $700. The in-network medical out-of-pocket maximum is $3,000; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $0. Member costs can depend on the Medicaid category the plan accepts and verifies. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS)?

CMS lists Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS) as a HMOPOS plan. The plan record says specialist referrals are required. The record also identifies point-of-service flexibility, but exact out-of-network rules can vary. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

Do I qualify for Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS)?

Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS) is listed in the current plan record as a D-SNP. You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.

Learn about Medicare Savings Programs

What extra benefits does Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS) offer for dual-eligible members?

The current plan record for Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS) lists dental ($5,000/yr comprehensive dental allowance), vision ($400/yr eyewear allowance), hearing ($1,000/yr hearing aid allowance), over-the-counter (OTC) ($67/month OTC allowance), and fitness ($0 fitness benefit). Member costs can depend on the Medicaid category the plan accepts and verifies. The record identifies Part D prescription drug coverage. Review the plan documents for benefit limits, eligibility rules, and how Medicare and Medicaid coverage work together.

When can I enroll in Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS)?

Wellcare Sunshine Health Dual Reserve (HMO-POS D-SNP) (HMOPOS) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a D-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

Plan documents

Summary of Benefits and Evidence of Coverage

Summary of Benefits (PDF)Download the plan's official Summary of Benefits document
Evidence of Coverage (PDF)Complete plan details and rules
Check Your DoctorsSee if your doctors accept this plan
Documentos en españolLlame a The Pocket Protector al 1-866-764-3312 (TTY: 711) para recibir ayuda con documentos en español

Enter your ZIP code to see how you can enroll

Enrollment options depend on where you live. Enter your ZIP code so we can show the right ways to enroll in this plan.

The Pocket Protector · NPN 21126942 · 1-866-764-3312 (TTY: 711) · thepocketprotector.com

Plan benefits, premiums, and copays may vary by county and plan. You must continue to pay your Medicare Part B premium. Benefits and costs may vary by service area. Contact the plan or CMS for complete details.

We unbiasedly compare all plans regardless of appointment or sales commissions. Agents are not bonused off commissionable sales. Agents are paid flat amounts and share in company financials across all businesses and products. Currently we represent multiple organizations which offer various products in your area. You can always contact Medicare.gov or 1-800-MEDICARE for help with plan choices.

Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings are based on 2027 data and may change annually.

Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of plan-approved items. Unused amounts will expire at the end of the month or quarter.

Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you to contact the plan.

Dental, hearing, vision, and other supplemental benefits may have limitations and restrictions. These benefits vary by plan. Please refer to the plan's Evidence of Coverage for details.

The plan formulary, pharmacy network, provider network, and/or copays may change at any time.

This spending allowance is a special supplemental program for members with specific health conditions. Qualifying conditions include diabetes mellitus, cardiovascular disorders, chronic and disabling mental health conditions, chronic lung disorders, or chronic heart failure, among others. Some plans may require at least two conditions and other requirements apply. See the plan's Evidence of Coverage for details.

Even if you have a listed chronic condition, you may not receive the benefit. Coverage also depends on the plan's specific coverage criteria for the SSBCI.

If you use this program for rent or utilities, Housing and Urban Development (HUD) requires it to be reported as income if you seek assistance. Contact your local HUD office if you have questions.

To join a Dual Eligible Special Needs Plan (D-SNP), you must be entitled to Medicare Part A, enrolled in Medicare Part B, and receive full Medicaid benefits or assistance from your state. Eligibility requirements vary by state and may require further verification. Enrollment in the plan depends on contract renewal.

Membership in this plan depends on your continued Medicaid eligibility. If you lose your Medicaid eligibility, you may be disenrolled from this plan. Contact your state Medicaid office or 1-800-MEDICARE (TTY: 1-877-486-2048) for more information.

Benefits shown are based on CMS public plan data. Actual benefits vary by county. Not all plans available in all areas. Speak with a licensed agent before enrolling.

The Pocket Protector represents Medicare Advantage HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal.
The Pocket Protector is not connected with or endorsed by the United States government or the federal Medicare program.