2017 Medicare Advantage Plans in San Diego County California

2017 Medicare Advantage Plans in San Diego County California

There are 16 Medicare Advantage Plans available in San Diego County CA from 9 health insurance providers and 7 Special Needs Plans available. 8 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3300 and the highest out of pocket is $6700. The highest rated plan available in San Diego County received a 5 overall star rating from CMS and the lowest rated plan is 3.5 stars.

(Click the Plan Name for More Details)

Name Monthly
Premium
C+D
Part D
Deductible
Type  Gap  Max Out
of
Pocket
Overall Rating Formulary
Aetna Medicare Choice Plan (PPO)
(H5521-053)
$73.00 $0.00 Local PPO Yes $6,700 Browse
Formulary
Aetna Medicare Select Plan (HMO)
(H0523-052)
$0.00 $0.00 Local HMO Yes $3,400 Browse
Formulary
Blue Shield 65 Plus (HMO)
(H0504-028)
$0.00 $0.00 Local HMO Yes $3,400 Browse
Formulary
Care1st AdvantageOptimum Plan (HMO)
(H5928-010)
$0.00 $0.00 Local HMO Yes $3,400 Browse
Formulary
Coordinated Choice Plan (HMO)
(H5928-037)
$36.20 $400.00 Local HMO Yes $6,700 Browse
Formulary
Health Net Healthy Heart (HMO)
(H0562-012)
$0.00 $100.00 Local HMO No $5,000 Browse
Formulary
Health Net Seniority Plus Sapphire (HMO)
(H0562-111)
$36.20 $140.00 Local HMO No $6,700 Browse
Formulary
Health Net Seniority Plus Sapphire Premier (HMO)
(H3561-002)
$36.20 $170.00 Local HMO No $6,700 Too NewBrowse
Formulary
Humana Gold Plus H5619-016 (HMO)
(H5619-016)
$0.00 $0.00 Local HMO Yes $4,900 Browse
Formulary
Humana Gold Plus H5619-037 (HMO)
(H5619-037)
$16.50 $400.00 Local HMO No $6,700 Browse
Formulary
Kaiser Permanente Senior Advantage San Diego (HMO)
(H0524-037)
$0.00 $0.00 Local HMO Yes $4,400 Browse
Formulary
Scripps Classic offered by SCAN Health Plan (HMO)
(H5425-005)
$0.00 $0.00 Local HMO No $3,400 Browse
Formulary
Scripps Plus offered by SCAN Health Plan (HMO)
(H5425-040)
$36.30 $400.00 Local HMO No $6,700 Browse
Formulary
Scripps Signature offered by SCAN Health Plan (HMO)
(H5425-004)
$74.00 $0.00 Local HMO Yes $4,000 Browse
Formulary
Sharp Advantage Select (HMO)
(H5386-003)
$0.00 $0.00 Local HMO No $3,500 NABrowse
Formulary
Sharp Advantage Select Plus (HMO)
(H5386-004)
$69.00 $0.00 Local HMO No $3,300 NABrowse
Formulary
Return to 2017 Medicare Advantage Plans in California

* Plan Type does not offer Medicare Part D drug coverage.



Medicare Special Needs Plans in San Diego county California

Plan Name Monthly
Consolidated
Premium C+D
Part D
Deductible
 Gap  Special Needs
Type
Overall Rating
Anthem MediBlue ESRD (PPO SNP)
(H8552- 028)
   $36.30 $380.00  No Chronic or Disabling ConditionBrowse
Formulary
Care1st TotalDual Plan (HMO SNP)
(H5928- 009)
   $36.20 $400.00  No Dual-EligibleBrowse
Formulary
Fresenius Total Health (PPO SNP)
(H9312- 002)
   $17.80 $400.00  No Chronic or Disabling ConditionToo NewBrowse
Formulary
Health Net Seniority Plus Amber II (HMO SNP)
(H0562- 110)
   $36.20 $155.00  No Dual-EligibleBrowse
Formulary
Molina Medicare Options Plus (HMO SNP)
(H5810- 001)
   $29.90 $400.00  No Dual-EligibleBrowse
Formulary
Scripps Heart First offered by SCAN Health Plan (HMO SNP)
(H5425- 055)
   $26.00 $0.00  Yes Chronic or Disabling ConditionBrowse
Formulary
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
(H0524- 029)
   $32.00 $0.00  No Dual-EligibleBrowse
Formulary


Plan Type Is the type of organization offering the Medicare Plans.

  • HMO - Health Maintenance Organization
  • PPO - Preferred Provider Organization
  • PDP - Prescription Drug Plan
  • SNP - Special Needs Plan
  • POS - Point of Service
  • PFFS - Private Fee For Service

Monthly Consolidated Premium (Includes Part C + D) Your premium may be lower depending on your eligibility for medical assistance. Call your provider for details.

Part D Total Premium: The Part D Total Premium is the sum of the Basic and Supplemental Premiums. Note: the Part D Total Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage; for some plans the total premium may be lower than the sum of the basic and supplemental premiums due to negative basic or supplemental premiums.

Benefit Type
  • (EA) Enhanced Alternative may offer additional gap coverage which is calculated as the percentage of “generic” formulary products with coverage above standard "generic" coverage gap cost-sharing benefit and/or the percentage of “brand” formulary products covered in addition to the coverage gap discount for applicable drugs.

  • (DS) Defined Standard Benefit
  • (BA) Basic Alternative
  • (AE) Actuarially Equivalent Standard

  • GAP

    In 2017 once you and your plan provider have spent $3700 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will pay 40% of the plans cost for covered brand-name prescription drugs and 51% on generic drugs unless your plan offers additional coverage.

    Maximum Out-of-Pocket (MOOP) limit on enrollee spending that includes costs for all in-network Part A and Part B Services. NOT Part D - prescription drugs. N/A is defined as Not Applicable



    Source: CMS.

    Data as of September 6, 2016.

    Plans are subject to change as contracts are finalized.

    Includes 2017 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2017, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.