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DualConnect (HMO D-SNP)
Santa Clara Family Health Plan

HMO D-SNPDual-EligibleSanta Clara CountyIncludes Part DPlan year 2026
This plan on Medicare.gov Evidence of Coverage (PDF) Find a doctor
$10/momonthly premium
$9,250most you pay in-network per year
3.5overall CMS star rating
11,689members 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.

44 services

Doctor visits

Primary care visit
20%
Coinsurance — your share of the bill
Specialist visit
20%
Coinsurance — your share of the bill
Other health care professional
20%
Coinsurance — your share of the bill
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
20%
Coinsurance — your share of the bill
Urgent care visit
20%
Coinsurance — your share of the bill

Mental health and substance use

Individual therapy session
20%
Coinsurance — your share of the bill
Group therapy session
20%
Coinsurance — your share of the bill
Opioid treatment program
20%
Coinsurance — your share of the bill
Partial hospitalization program
20%
Coinsurance — your share of the bill
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

Lab services
20%
Coinsurance — your share of the bill
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
Blood services
20%
Coinsurance — your share of the bill

Ambulance

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

Medical equipment and supplies

Durable medical equipment
20%
Coinsurance — your share of the bill
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

Preventive and wellness

Barium enema
20%
Coinsurance — your share of the bill
Diabetes screening
20%
Coinsurance — your share of the bill
Digital rectal exam
20%
Coinsurance — your share of the bill
Electrocardiogram (EKG)
20%
Coinsurance — your share of the bill
Glaucoma screening
20%
Coinsurance — your share of the bill

Vision

Eye exam (Medicare-covered)
20%
Coinsurance — your share of the bill
Eyewear allowance
Up to $200 every two years
Allowance

Hearing

Hearing exam (Medicare-covered)
20%
Coinsurance — your share of the bill

Extra benefits

Over-the-counter items
Up to $100 every three months
Allowance

Extra benefits beyond Original Medicare

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

3 offered · 19 not offered

Health Education

Cost not publishedMandatory · prior authorization required · referral required
Included

Fitness Benefit

Physical Fitness

Cost not publishedMandatory · prior authorization required · referral required
Included

Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)

Nursing Hotline; Web/Phone-based technologies

Cost not publishedMandatory · prior authorization required · referral required
Included

Not offered by this plan

In-Home Safety AssessmentPersonal Emergency Response System (PERS)Medical 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 ServicesHome and Bathroom Safety Devices and ModificationsCounseling Services

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
6. Select Care Drugs—0% coinsurance——Waived

Initial coverage

TierPreferred retailStandard retailMail orderInsulinDeductible
1. Generic—25% coinsurance——Applies
2. Preferred Brand—25% coinsurance——Applies
3. Non-Preferred Brand—25% coinsurance——Applies
4. Preferred Specialty Tier specialty—25% coinsurance——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. GenericNo copayNo copayNo copay—Applies
2. Preferred BrandNo copayNo copayNo copay—Applies
3. Non-Preferred BrandNo copayNo copayNo copay—Applies
4. Preferred Specialty Tier specialtyNo 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.

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

Staying healthy: screenings, tests and vaccines

4
  • Annual flu vaccine5
  • Breast cancer screening3
  • Colorectal cancer screening3
  • Monitoring physical activity5

Managing chronic (long-term) conditions

3
  • Readmissions3
  • Kidney health4
  • Blood pressure2
  • Reducing falls4
  • Statin therapy5
  • Pain assessment3
  • Medication review3
  • Diabetes eye exam4
  • Transitions of care2
  • Diabetes blood sugar3
  • Osteoporosis management2
  • Followup after emergency department visit2
  • Medication reconciliation2
  • Special needs plan SNP care management1

Member experience with the health plan

2
  • Customer service1
  • Care coordination1
  • Healthcare quality3
  • Health plan rating4
  • Getting needed care1
  • Getting appointments2

Member complaints and changes in the plan's performance

5
  • Complaints5
  • Members leaving5
  • Quality improvement4

Health plan customer service

3
  • Call center3
  • Timely decisions3
  • Appeals decisions2

Drug plan customer service

4
  • Call center foreign language interpreter and TTY availability4

Drug plan complaints and changes

5
  • Complaints5
  • Members leaving5
  • Quality improvement5

Member experience with the drug plan

3
  • Drug plan rating4
  • Prescription drugs2

Drug safety and accuracy of drug pricing

4
  • Price accuracy4
  • Statin diabetes4
  • Medication therapy management comprehensive medication review completion4
  • Medication adherence for diabetes medications4
  • Medication adherence for hypertension RAS antagonists s3
  • Medication adherence for cholesterol statins3

Service area and network

Sold in 1 California county.

Santa Clara

Doctor directory

3,374 providers are named in Santa Clara Family Health Plan’s directory for this plan, dated Sep 1, 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. Open the carrier directory

Contract with Medicare sinceJan 1, 2023
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.