CalOptima Health OneCare Complete (HMO D-SNP)
CalOptima Health OneCare · HMO D-SNP · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $7.30
- Most you pay in a year for covered care in network
- $9,850
- Drug deductible
- $700
- Medicare star rating
- No rating yet
This is a special needs plan. Only some people can join: Dual-Eligible.
In plain English
Compared with the 2 other plans in Orange County that the same person could join.
What stands out
- Dental, vision and hearing extras included
Watch out for
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$87.60$87.60 in premiums + $0 for care2 checkups and 2 lab tests.Not counted, because the plan charges a percentage: Primary care visit, Lab tests.
- A busier year$87.60$87.60 in premiums + $0 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Not counted, because the plan charges a percentage: Primary care visit, Specialist visit, Lab tests, X-rays, Urgent care.
- A hard year$87.60$87.60 in premiums + $0 for care6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Not counted, because the plan charges a percentage: Primary care visit, Specialist visit, Lab tests, MRI, CT and other scans, Ground ambulance, Emergency room, Hospital stay.
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 visit20%
- Specialist visit20%Referral neededPlan approval may be needed
- Urgent care20%
- Emergency room20%
- Lab tests20%Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center20%Referral neededPlan approval may be needed
- Outpatient hospital care20%
- X-rays20%Referral neededPlan approval may be needed
- MRI, CT and other scans20%Referral neededPlan approval may be needed
- Ground ambulance20%Plan approval may be needed
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 2 other plans in Orange County that the same person could join. Read the plan’s 2027 booklet (PDF)
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay $0.
- Vision IncludedRoutine eye exam covered. Glasses or contacts covered.Eyewear: plan pays up to $500 every two years.
- Hearing IncludedHearing aids covered.Hearing aids: plan pays up to $500 a year, both ears.
- Over-the-counter items IncludedUp to $170 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes and a home fitness kit.
- Rides to care Not included
What changed from 2026
- Monthly premium2026$12 a month2027$7.30 a month
- Most you pay in a year2026$9,2502027$9,850
- Drug deductible2026$6152027$700
- Lab tests2026$0202720%
- Over-the-counter items2026Up to $167 every three months for things like vitamins, pain relief and bandages. Unused money does not carry over2027Up to $170 every three months for things like vitamins, pain relief and bandages. Unused money does not carry over
- Fitness2026Includes gym or fitness classes2027Includes gym or fitness classes and a home fitness kit
- Rides to care2026Rides to medical visits, no set number2027Not covered
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take CalOptima Health OneCare Complete (HMO D-SNP), plan number H5433-001, for 2027?”
Check my medicines
See if this plan covers each medicine you take in 2027.
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.