California Medicare Advantage Plan (2025 Plan)
Blue Shield AdvantageOptimum Plan 1 (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in California and offered by the health insurance company Blue Shield of California. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Blue Shield AdvantageOptimum Plan 1 (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $4,200 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Blue Shield AdvantageOptimum Plan 1 (HMO) are defined below.
Blue Shield AdvantageOptimum Plan 1 (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Blue Shield AdvantageOptimum Plan 1 (HMO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Blue Shield AdvantageOptimum Plan 1 (HMO) includes coverage for the following additional benefits:
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Blue Shield AdvantageOptimum Plan 1 (HMO) received an overall government quality rating of 3.5 stars out of 5 stars.
Blue Shield AdvantageOptimum Plan 1 (HMO) performed the same as California’s State average overall quality score of 3.5 stars.
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Blue Shield AdvantageOptimum Plan 1 (HMO) received 3.5 stars for its health plan quality score which is better than the California State average health plan quality score of 3.4 stars.
Blue Shield AdvantageOptimum Plan 1 (HMO) received 3.5 stars for its drug plan quality score which is worse than the California State average drug plan quality score of 3.8 stars.
| Tiers | Initial coverage phase | Catastrophic coverage phase |
|---|---|---|
| Preferred Generic | $3.00 copay | $0 copay |
| Generic | $10.00 copay | $0 copay |
| Preferred Brand | $47.00 copay | $0 copay |
| Non-Preferred Drug | $100.00 copay | $0 copay |
| Specialty Tier | 33% coinsurance | $0 copay |
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Health Plan RadarIn this article we rank California Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.
Health Plan RadarThe Medicare landscape in California is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in California.
