TotalCare (HMO D-SNP)
Central California Alliance for Health · HMO D-SNP · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $5.50
- Most you pay in a year for covered care in network
- $9,250
- Drug deductible
- $615
- 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 1 other plans in Mariposa County that the same person could join.
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$66$66 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$66$66 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$66$66 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 needed
- Urgent care20%
- Emergency room20%
- Lab tests20%Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center20%Plan 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 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 1 other plans in Mariposa County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2GenericAfter the deductible | 25% of the price |
| 3Preferred BrandAfter the deductible | 25% of the price |
| 4Non-Preferred DrugAfter the deductible | 30% of the price |
| 5Specialty TierAfter the deductible | 25% of the price |
| 6Select Care Drugs | $0 |
For a 1-month supply. The $615 drug deductible applies only to the tiers marked. 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 Not included
- Vision IncludedRoutine eye exam covered. Glasses or contacts covered.Eyewear: plan pays up to $350 every two years.
- Hearing Not included
- Over-the-counter items IncludedUp to $100 every three months for things like vitamins, pain relief and bandages.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not included
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 TotalCare (HMO D-SNP), plan number H5692-001, for 2026?”