CareAdvantage (HMO D-SNP)
HEALTH PLAN OF SAN MATEO · 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.
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$1,027.60$87.60 in premiums + $940 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.
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%
- Urgent care20%
- Emergency room20%
- Hospital stay$940 per stayPlan approval may be needed
- Lab tests20%
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center20%Plan approval may be needed
- Outpatient hospital care20%
- X-rays20%Plan approval may be needed
- MRI, CT and other scans20%Plan approval may be needed
- Ground ambulance20%Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $221 a day for days 21 to 100Plan 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 1 other plans in San Mateo County that the same person could join. Read the plan’s 2027 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1GenericAfter the deductible | 24% of the price |
| 2BrandAfter the deductible | 25% of the price |
For a 1-month supply. You pay full price until you have paid the $700 drug deductible. 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 2027, 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 $175 a year.
- Hearing Not included
- Over-the-counter items IncludedUp to $37 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included12 one-way rides to medical visits a month.
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
- Hospital stay2026$1,157 per stay2027$940 per stay
- Skilled nursing facility2026$0 for days 1 to 20, then $218 a day for days 21 to 1002027$0 for days 1 to 20, then $221 a day for days 21 to 100
- Over-the-counter items2026Up to $75 every three months for things like vitamins, pain relief and bandages. Unused money does not carry over2027Up to $37 every three months for things like vitamins, pain relief and bandages. Unused money does not carry over
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 CareAdvantage (HMO D-SNP), plan number H6019-001, for 2027?”