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The 2019 Medicare Advantage Plans in Santa Clara County CA.
2018 Medicare Advantage Plans in Santa Clara County California
There are 15 Medicare Advantage Plans available in Santa Clara County CA from 9 different health insurance providers. 8 of these Medicare Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3000 and the highest out of pocket is $6700. The highest rated plan available in Santa Clara County received a 5 overall star rating from CMS and the lowest rated plan is 3.5 stars. Santa Clara County California residents can also pick from 8 Medicare Special Needs Plans.
(Click the Plan Name for More Details)
* Plan Type does not offer Medicare Part D drug coverage.
2018 Medicare Special Needs Plans in Santa Clara county California
| Plan Name | Monthly Consolidated Premium C+D |
Part D Deductible |
Gap | Special Needs Type |
Overall Rating |
| Anthem Breathe (HMO SNP) (H0544- 024) |
$55.00 | $0.00 | Yes | Chronic or Disabling Condition | |
| Anthem Connect (HMO SNP) (H0544- 041) |
$0.00 | $405.00 | Yes | Dual-Eligible | |
| Anthem Diabetes (HMO SNP) (H0544- 025) |
$55.00 | $0.00 | Yes | Chronic or Disabling Condition | |
| Anthem Heart (HMO SNP) (H0544- 037) |
$55.00 | $0.00 | Yes | Chronic or Disabling Condition | |
| Anthem Touch (HMO SNP) (H0544- 050) |
$0.00 | $0.00 | Yes | Institutional | |
| Brand New Day Embrace Care Drug Savings (HMO SNP) (H0838- 035) |
$0.00 | $0.00 | Yes | Chronic or Disabling Condition | |
| Brand New Day Embrace Choice for Medi-Medi (HMO SNP) (H0838- 036) |
$35.50 | $405.00 | No | Chronic or Disabling Condition | |
| Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) (H0524- 030) |
$32.00 | $405.00 | No | Dual-Eligible |
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 2018 once you and your plan provider have spent $3750 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 35% of the plans cost for covered brand-name prescription drugs and 44% 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 5, 2017.
Plans are subject to change as contracts are finalized.
Includes 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2018, 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.
