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Astiva Health C-SNP WOW - NorCal (HMO C-SNP)
Astiva Health

HMO C-SNPChronic or Disabling ConditionSanta Clara CountyIncludes Part DPlan year 2026
This plan on Medicare.gov Evidence of Coverage (PDF) Find a doctor
$12/momonthly premium
$9,250most you pay in-network per year
3.5overall CMS star rating
79members enrolled, January 2026

Plan-level limits

Premium, deductibles, and the most you can pay out of pocket in a year.

In-network out-of-pocket maximum$9,250
Plan premium, per month$0

What a year on this plan would likely cost

What you pay for care

In-network costs for every service in this plan's CMS benefit filing. A copay is a fixed dollar amount; coinsurance is a percentage of the bill.

35 services

Hospital stays

Inpatient psychiatric stay
Days 91–150$816 per dayExtra days beyond what Original Medicare covers
Skilled nursing facility stay
Days 1–20$0 per day
Days 21–100$218 per day

Doctor visits

Chiropractic care (Medicare-covered)
20%
Coinsurance — your share of the bill
Podiatry (Medicare-covered)
20%
Coinsurance — your share of the bill

Emergency and urgent care

Emergency room visit
$70
Copay
Emergency care outside the U.S.
Up to $50,000
Allowance

Mental health and substance use

Individual therapy session
$50
Copay
Group therapy session
$50
Copay
Opioid treatment program
$15
Copay
Partial hospitalization program
$80
Copay
Referral required
Prior authorization required

Therapy and rehabilitation

Occupational therapy
20%
Coinsurance — your share of the bill
Physical and speech therapy
20%
Coinsurance — your share of the bill
Cardiac rehabilitation
20%
Coinsurance — your share of the bill
Intensive cardiac rehabilitation
20%
Coinsurance — your share of the bill
Pulmonary rehabilitation
20%
Coinsurance — your share of the bill
Supervised exercise therapy for peripheral artery disease
20%
Coinsurance — your share of the bill

Tests, labs and imaging

Diagnostic tests
20%
Coinsurance — your share of the bill
X-rays
$20
Copay
Diagnostic radiology (MRI, CT, PET)
20%
Coinsurance — your share of the bill
Therapeutic radiology
20%
Coinsurance — your share of the bill

Outpatient hospital and surgery

Outpatient hospital services
20%
Coinsurance — your share of the bill
Ambulatory surgical center
20%
Coinsurance — your share of the bill
Observation services
20%
Coinsurance — your share of the bill

Ambulance

Ground ambulance
$200
Copay
Air ambulance
20%
Coinsurance — your share of the bill

Medical equipment and supplies

Durable medical equipment
0–20%
Coinsurance, depends on the service
Medical supplies
20%
Coinsurance — your share of the bill
Prosthetic devices
20%
Coinsurance — your share of the bill

Dialysis

Dialysis
20%
Coinsurance — your share of the bill

Part B drugs

Part B drugs
0–20%
Coinsurance, depends on the service
Chemotherapy drugs
0–20%
Coinsurance, depends on the service
Part B insulin
0–20%
Coinsurance, depends on the service
Never more than $35 for a one-month supply

Vision

Eyewear allowance
Up to $300 every two years
Allowance

Hearing

Prescription hearing aids
Up to $500 per year, both ears combined
Allowance

Extra benefits

Other plan benefit
Up to $600 per year
Allowance

Extra benefits beyond Original Medicare

Supplemental benefits this plan filed with CMS, with the cap and period exactly as filed.

2 offered · 20 not offered

Personal Emergency Response System (PERS)

Cost not publishedMandatory
Included

Fitness Benefit

Physical Fitness

Cost not publishedMandatory
Included

Not offered by this plan

Health EducationIn-Home Safety AssessmentMedical Nutrition Therapy (MNT)Post discharge In-Home Medication ReconciliationRe-admission PreventionWigs for Hair Loss Related to ChemotherapyWeight Management ProgramsAlternative TherapiesTherapeutic MassageAdult Day Health ServicesNutritional/Dietary BenefitHome-Based Palliative CareIn-Home Support ServicesSupport for Caregivers of EnrolleesAdditional Sessions of Smoking and Tobacco Cessation CounselingEnhanced Disease ManagementTelemonitoring ServicesRemote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Home and Bathroom Safety Devices and ModificationsCounseling Services

Dental

$350 every three months allowance, shared by preventive and comprehensive services. No dental deductible.

Preventive

Oral examsMandatory
CleaningsMandatory
X-raysMandatory
Fluoride treatmentMandatory
Other diagnostic servicesMandatory
Other preventive servicesMandatory

Comprehensive

Restorative (fillings)Mandatory
Endodontics (root canals)Mandatory
Periodontics (gum treatment)Mandatory
Oral surgeryMandatory
Fixed prosthodontics (crowns, bridges)Mandatory
Removable prosthodontics (dentures)Mandatory
Adjunctive general servicesMandatory

Prescription drugs (Part D)

$615 annual drug deductible · 6 formulary tiers · mail order available. Costs shown for a 30-day supply.

Before the deductible

TierPreferred retailStandard retailMail orderInsulinDeductible
1. Preferred Generic—No copay——Waived
2. Generic—$15 copay——Waived
6. Select Care Drugs—No copay——Waived

Initial coverage

TierPreferred retailStandard retailMail orderInsulinDeductible
1. Preferred Generic—No copay——Waived
2. Generic—$15 copay——Waived
3. Preferred Brand—$45 copay——Applies
4. Non-Preferred Drug—$100 copay——Applies
5. Specialty Tier specialty—25% coinsurance——Applies
6. Select Care Drugs—No copay——Waived

Catastrophic (after the out-of-pocket threshold)

TierPreferred retailStandard retailMail orderInsulinDeductible
1. Preferred GenericNo copayNo copayNo copay—Waived
2. GenericNo copayNo copayNo copay—Waived
3. Preferred BrandNo copayNo copayNo copay—Applies
4. Non-Preferred DrugNo copayNo copayNo copay—Applies
5. Specialty Tier specialtyNo copayNo copayNo copay—Applies
6. Select Care DrugsNo copayNo copayNo copay—Waived

Out-of-pocket threshold for the catastrophic phase: $2,100.

Is my medicine on this plan’s list?

Pharmacies near you in this plan's network

From the plan's filed Part D pharmacy network, matched to geocoded pharmacy locations. Preferred pharmacies come first: they carry the lower copay column in the tier table above. The ZIP you enter stays in this browser.

CMS star ratings

Star ratings are set by CMS for the whole contract, so every plan under this contract shares them.

40 measures
3.5 out of 5Overall rating
4 out of 5Health services (Part C)
3.5 out of 5Drug plan (Part D)

Staying healthy: screenings, tests and vaccines

4
  • Annual flu vaccine5
  • Breast cancer screening2
  • Colorectal cancer screening3
  • Monitoring physical activity5
  • Improving or maintaining mental health3
  • Improving or maintaining physical health5

Managing chronic (long-term) conditions

3
  • Readmissions4
  • Kidney health4
  • Blood pressure4
  • Statin therapy3
  • Pain assessment3
  • Bladder control5
  • Medication review3
  • Diabetes eye exam4
  • Transitions of care1
  • Diabetes blood sugar3
  • Followup after emergency department visit2
  • Medication reconciliation2
  • Special needs plan SNP care management1

Member experience with the health plan

4
  • Customer service5
  • Care coordination5
  • Healthcare quality3
  • Health plan rating4
  • Getting needed care5

Member complaints and changes in the plan's performance

4
  • Complaints4
  • Members leaving4
  • Quality improvement4

Health plan customer service

  • Call center3

Drug plan customer service

3
  • Call center foreign language interpreter and TTY availability3

Drug plan complaints and changes

4
  • Complaints4
  • Members leaving4
  • Quality improvement3

Member experience with the drug plan

5
  • Drug plan rating5
  • Prescription drugs4

Drug safety and accuracy of drug pricing

4
  • Price accuracy5
  • Statin diabetes5
  • Medication therapy management comprehensive medication review completion3
  • Medication adherence for diabetes medications4
  • Medication adherence for hypertension RAS antagonists s3
  • Medication adherence for cholesterol statins2

Service area and network

Sold in 1 California county.

Santa Clara

Doctor directory

12,821 providers are named in Astiva Health’s directory for this plan, dated Jul 31, 2026.

A doctor named there is listed. A doctor missing from it is unknown, never out of network: carrier directories are partial and change monthly.

Contract with Medicare sinceJan 1, 2021
Medicare Advantage regionCalifornia

Ask about this plan

A question box grounded in this plan's filed benefits, drug list, and pharmacy network. It reads the same records shown on this page and says so when something is not filed.

Answers come from this plan’s filed benefits, drug list, and pharmacy network. They are not enrollment advice; the Evidence of Coverage is the final word.