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Read more →CareAdvantage (HMO D-SNP)
by HEALTH PLAN OF SAN MATEO
2027 Medicare-Medicaid Dual Eligible D-SNP plan available in California
Plan ID H6019-001-0
Additional coverage:
RxHearingVision
Medicare-Medicaid Dual Eligible D-SNP HMO $0 premium 3.0 Overall
Monthly plan premium $0 / mo
Annual deductible $0 / yr
Max out-of-pocket · in-network $9,850 / yr
Drug deductible $700 / yr
3.0 Overall Government Star Rating 2027 · out of 5 stars
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Plan Overview
CareAdvantage (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in California and offered by the health insurance company HEALTH PLAN OF SAN MATEO. This plan's network type is HMO, which determines the in-network doctors who accept the plan and whether a referral is needed.
Plan Name CareAdvantage (HMO D-SNP)
Insurance Carrier HEALTH PLAN OF SAN MATEO
Plan Type Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type HMO
Cost Summary
CareAdvantage (HMO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $9,850. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.
Monthly Premium $0 / mo
Health portion of premium $0
Drug portion of premium $0
Annual Deductible $0 / yr
Max Out-of-Pocket · in-network $9,850 / yr
Primary doctor visit $0 copay
Specialist visit $0 copay
ER visit $0 copay
Ambulance $0 copay
Additional Benefits and Coverage
CareAdvantage (HMO D-SNP) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. CareAdvantage (HMO D-SNP) includes coverage for hearing, vision.
Part D Prescription Drug Coverage Yes
Dental No
Vision Yes
Hearing Yes
Nationwide Coverage No
Other benefits
Fitness benefit Limited coverage
Over-the-counter drug benefits Limited coverage
In-home support services Limited coverage
Home & bathroom safety devices Limited coverage
Meals for short duration Limited coverage
Annual physical exams Limited coverage
Telehealth Limited coverage
Medical Benefits
Doctor Services
Primary doctor visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Specialist visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Tests, labs & imaging
Diagnostic tests & procedures In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Lab services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient x-rays In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Emergency care $0 copay
Urgent care $0 copay
Hospital Services
Inpatient hospital coverage Tier 1
$0 per stay
$0 per stay
Outpatient hospital coverage In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Skilled nursing facility
Skilled nursing facility Tier 1
$0 per day for days 1-20
$0 per day for days 21-100
$0 per day for days 1-20
$0 per day for days 21-100
Preventive services
Preventive services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Therapy services
Occupational therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Mental health services
Outpatient group therapy with a psychiatrist In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy with a psychiatrist In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient group therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Opioid treatment services
Opioid treatment services Covered
Other services
Durable medical equipment (like wheelchairs & oxygen) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Prosthetics (like braces, artificial limbs) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Diabetes supplies In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Prescription drugs (Part D benefits)
Drug tier standard retail · 1-month supply Initial coverage Catastrophic
Preferred Generic
Generic 24% coinsurance $0 copay
Preferred Brand
Non-Preferred Drug
Specialty Tier
Part B drugs
Chemotherapy drugs In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Other Part B drugs In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Medicare star rating
Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2027, CareAdvantage (HMO D-SNP) earned an overall rating of 3.0 stars — worse than California's state average of 3.9 stars.
Rating category This plan State average
Overall star rating ★ 3.0 3.9
Health plan quality
Summary rating of health plan quality ★ 3.5 4.0
Staying healthy: screenings, tests & vaccines ★ 4.0 4.3
Managing chronic (long-term) conditions ★ 3.0 4.2
Member experience with health plan ★ 2.0 2.8
Member complaints & changes in performance ★ 5.0 4.5
Health plan customer service ★ 4.0 3.9
Drug plan quality
Summary rating of drug plan quality ★ 3.0 4.2
Drug plan customer service ★ 3.0 4.0
Member complaints & changes in performance ★ 4.0 4.4
Member experience with the drug plan – 3.0
Drug safety & accuracy of drug pricing ★ 2.0 3.7
Extra Benefits
Hearing
Hearing exam Not covered
Fitting/evaluation Not covered
Hearing aids - prescription Not covered
Hearing aids - over the counter Not covered
Preventive dental
Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-rays Not covered
Comprehensive dental
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Prosthodontics, removable Not covered
Prosthodontics, fixed Not covered
Maxillofacial prosthetics Not covered
Implant services Not covered
Oral and maxillofacial surgery Not covered
Orthodontics Not covered
Adjunctive general services Not covered
Vision
Routine eye exam In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Contact lenses In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only) Not covered
Eyeglass lenses (only) Not covered
Upgrades Not covered
Plan documents & tools
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