Gold Coast Health Plan Total Care Advantage (HMO D-SNP)
Gold Coast Health Plan · HMO D-SNP · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $12
- Highest of 6 plans here
- Most you pay in a year for covered care in network
- $9,250
- Drug deductible
- $615
- Tied for highest here
- 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 5 other plans in Ventura County that the same person could join.
Watch out for
- $12 monthly premium, highest of 6 plans here
- $615 drug deductible, tied for highest here
- No dental extra, though most plans here have one
- 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$144$144 in premiums + $0 for careHighest of 6 plans here2 checkups and 2 lab tests.Not counted, because the plan charges a percentage: Primary care visit, Lab tests.
- A busier year$144$144 in premiums + $0 for careHighest of 6 plans here4 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$144$144 in premiums + $0 for careHigher 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.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 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 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 5 other plans in Ventura County that the same person could join. Read the plan’s 2026 booklet (PDF)
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 a year.
- Hearing IncludedRoutine hearing test covered. Hearing aids covered.
- Over-the-counter items Not included
- Fitness IncludedIncludes gym or fitness classes and memory fitness.
- 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 Gold Coast Health Plan Total Care Advantage (HMO D-SNP), plan number H9623-001, for 2026?”
Check my medicines
See if this plan covers each medicine you take in 2026.
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.