Astiva Health Premier Plan - NorCal (HMO)
Astiva Health · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $1,500
- Lower than most plans here
- Drug deductible
- $0
- Most you pay for covered drugs in a year
- $2,100
- Medicare star rating
- 4 of 5
In plain English
Compared with the 25 other plans in Santa Clara County that the same person could join.
What stands out
- No monthly premium
- At most $1,500 a year for covered care, lower than most plans here
- $0 for a 5-day hospital stay, tied for lowest here
- $85 for the emergency room, lower than most plans here
Watch out for
- You need a referral to see a specialist
- Covers only the plan’s own doctors and hospitals, except in an emergency or for urgent care
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$0$0 in premiums + $0 for careTied for lowest here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$295$0 in premiums + $295 for careLower than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Uses the highest listed cost for: MRI, CT and other scans.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0Referral neededPlan approval may be needed
- Urgent care$0
- Emergency room$85Lower than most plans hereNot charged if you stay in the hospital within 48 hours
- Hospital stay$0Tied for lowest hereReferral neededPlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, scans, mental health, therapy, home health and more
- Outpatient surgery center$75Lower than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$0Tied for lowest here
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$0 to $30Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$150Lower than most plans herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 100Referral neededPlan approval may be needed
- Mental health therapy visit$0Tied for lowest hereReferral neededPlan approval may be needed
- Psychiatrist visit$40Tied for highest hereReferral neededPlan approval may be needed
- Physical or speech therapy$0Referral neededPlan approval may be needed
- Occupational therapy$0Referral neededPlan approval may be needed
- Home health care$0Referral neededPlan approval may be needed
- Medical equipment, like a walker or oxygen0% to 20%Depends on the servicePlan approval may be needed
- Kidney dialysis20%Referral neededPlan approval may be needed
- Chemotherapy and radiation drugs0% to 20%Depends on the servicePlan approval may be needed
- Other drugs given at a clinic0% to 20%Depends on the servicePlan approval may be needed
- Heart rehab$0Referral neededPlan approval may be needed
- Foot doctor (podiatrist)$0Referral neededPlan approval may be needed
- Chiropractor$0Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 25 other plans in Santa Clara County that the same person could join. Read the plan’s 2026 booklet (PDF)
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Add your doctors once. We’ll check them against each plan you look at.
Before you choose, call each doctor’s office and ask:
“Do you take Astiva Health Premier Plan - NorCal (HMO), plan number H1993-012, for 2026?”
What medicines cost
The most you pay for covered drugs in 2026 is $2,100. After that, covered drugs cost $0 for the rest of the year.
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $0 |
| 3Preferred Brand | $35 |
| 4Non-Preferred Drug | $95 |
| 5Specialty Tier | 33% of the price |
| 6Select Care Drugs | $0 |
For a 1-month supply. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay $0.Cleanings and exams: plan pays up to $875 every three months. Plan pays up to $875 every three months for all dental.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $300 every two years.
- Hearing IncludedHearing test: $0. Hearing aids covered.Hearing aids: plan pays up to $500 a year, both ears.
- Over-the-counter items IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included24 one-way rides to medical visits a year.
- Help at home IncludedIncludes an emergency call button.Ask the plan who can get it.
Help paying for this plan
Programs that can lower your Medicare costs if your income is limited.
Extra Help with drug costs
The drug part of this plan’s premium is already $0, so Extra Help would not lower the premium.
Extra Help also lowers what you pay for each medicine.
See who can get Extra HelpHelp with your Part B premium
A Medicare Savings Program can pay your Part B premium, and for some people more of their Medicare costs.
See who can get a Medicare Savings ProgramContact the plan
- Call about joining(866) 610-0655 · TTY 711
- Plan websiteastivahealth.com
- Full 2026 rulesRead the plan’s booklet (PDF)
From the details the plan filed with Medicare for 2026. To check whether a doctor takes this plan, call the doctor’s office, not the plan.