Shuman Roy is an entrepreneur, business owner, and musician. He started RoysNoys, LLC in 2013 as a music production and education service company. He also offers small business consulting and advisory services to help businesses get from start-up mode to turn-key operations. Shuman earned his M.B.A from the Stern School of Business in 2001 and has an undergraduate degree from Manhattan College in ...

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Joel Ohman is the CEO of a private equity-backed digital media company. He is a CERTIFIED FINANCIAL PLANNER™, author, angel investor, and serial entrepreneur who loves creating new things, whether books or businesses. He has also previously served as the founder and resident CFP® of a national insurance agency, Real Time Health Quotes. He has an MBA from the University of South Florida. Joel...

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Reviewed by Joel Ohman
Founder, CFP®

UPDATED: Oct 29, 2021

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The Highlights

  • You can choose from California HMO and PPO Medicare Advantage plans
  • If you choose Medicare Advantage, you’ll still need to pay your California original Medicare premium
  • Standalone Medicare Part D Plans in California are meant to help cover prescription drug costs

There are several options in California for Medicare Advantage plans. Medicare Advantage (Medicare Part C) is offered by 36 companies in California; and options such as HMO, PPO, and POS may be available depending on which county you live in.

To make sure you’re getting the best CA Medicare provider and plan for your needs, compare rates and out-of-pocket costs to find the ideal coverage and cost combination for you.

If you’re ready to compare Medicare plans from the top companies in your county or across California, enter your ZIP code for fast, free CA Medicare quotes today.

Table of Contents

The Complete List of California Medicare Advantage Companies

There are many companies offering Part C Medicare Advantage in CA. Below, you’ll find a complete listing of health insurance companies that offer Medicare Advantage plans in California, the counties those plans are offered in, and the number of plans each company offers.

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Medicare Advantage Companies in California

Company Number of Plans Counties
AHF 1 Los Angeles
Aetna 1 Alameda, Kern, Fresno, Marin, San Francisco, Ventura
Aetna Medicare 7 Orange, San Diego, Kern, Los Angeles, Fresno, Ventura, San Bernardino, Alameda, Marin, Riverside, Santa Clara, San Francisco, Stanislaus, Placer, San Joaquin, Yolo, Sacramento
Alignment Health Plan 13 Orange, San Diego, Los Angeles, San Luis Obispo, Santa Clara, Ventura, San Joaquin, Marin, Riverside, San Bernardino, Stanislaus, San Francisco, San Mateo, Sonoma, Placer, Santa Cruz, Yolo, Sacramento
Anthem 15 Orange, Stanislaus, Los Angeles, San Bernardino, Santa Clara, San Diego, Madera, Kern, Merced, San Joaquin, Monterey, Fresno, San Luis Obispo, Tulare, Ventura, Kings, Yuba, Sutter, Tehama, Sonoma, Napa, Solano, Shasta, El Dorado, Butte, San Francisco, Sacramento, San Benito
Anthem Blue Cross 8 Orange, Alameda, San Diego, San Mateo, Madera, Kern, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, Yolo, San Bernardino, Santa Clara, San Francisco, Ventura, Kings, Sacramento, Stanislaus, San Benito
Anthem Blue Cross Life and Health Insurance Co 1 Orange, Yuba, Sutter, Tehama, Sonoma, Napa, Solano, Shasta, El Dorado, Butte
Aspire Health Plan 3 Monterey
Astiva Health 2 Orange, San Diego
Blue Shield of California 12 Orange, Stanislaus, Merced, San Joaquin, Los Angeles, Fresno, Santa Clara, San Diego, San Bernardino, Riverside, Alameda, San Mateo, Madera, Sacramento, Kern, Santa Barbara, San Luis Obispo, Ventura
Brand New Day 14 Orange, San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, Santa Clara, San Francisco, Kings, Sacramento
Brandman Health Plan 4 Los Angeles
CCHP Health Plan 1 San Francisco
Central Health 3 Orange, Los Angeles, San Bernardino, Ventura
Central Health Medicare Plan 3 Orange, Los Angeles, Riverside, San Bernardino, Ventura
Chinese Community Health Plan 2 San Mateo, San Francisco
Clever Care Health Plan 2 Orange, San Diego, Los Angeles
Golden State 2 Orange, San Diego, Stanislaus, San Joaquin, Los Angeles, San Luis Obispo, Riverside, San Bernardino, San Francisco
Golden State Medicare Health Plan 1 Orange, Stanislaus, Los Angeles, San Luis Obispo, Riverside
HEALTH NET COMMUNITY SOLUTIONS, INC 2 Orange, Alameda, San Diego, Kern, Imperial, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, San Francisco
Health Net 4 Orange, San Diego, Kern, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, San Francisco, Sacramento
Health Net of California 6 Orange, Los Angeles, Riverside, San Bernardino, San Diego, Kern, Stanislaus, Santa Clara, Alameda, Placer, Imperial, Fresno, Yolo, San Francisco, Sacramento
Humana 17 Orange, San Diego, Los Angeles, Riverside, San Bernardino, Kern, Ventura, Madera, Stanislaus, San Joaquin, Fresno, San Luis Obispo, Tulare, Kings, Contra Costa, Santa Barbara
Imperial Health Plan of California 2 Orange, Alameda, San Diego, San Mateo, Madera, Kern, Contra Costa, Stanislaus, Merced, Santa Barbara, Placer, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, Yolo, San Bernardino, Santa Clara, San Francisco, Ventura, Kings, Sacramento
Imperial Health Plan of California, Inc 3 Orange, Alameda, San Diego, San Mateo, Madera, Kern, Contra Costa, Stanislaus, Merced, Santa Barbara, Placer, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, Yolo, San Bernardino, Santa Clara, San Francisco, Ventura, Kings, Sacramento
Inter Valley Health Plan 3 Orange, Los Angeles, Riverside, San Bernardino
Kaiser Permanente 26 Orange, San Diego, Kern, Los Angeles, Riverside, San Bernardino, Ventura, Alameda, Napa, San Francisco, Yuba, San Mateo, Madera, Contra Costa, Mariposa, Sutter, Stanislaus, Amador, Solano, Placer, San Joaquin, Santa Cruz, Fresno, Marin, Tulare, Yolo, El Dorado, Santa Clara, Kings, Sacramento, Sonoma
Molina Healthcare 1 San Diego, Imperial, Los Angeles, Riverside, San Bernardino
OneCare 1 Orange
SCAN Health Plan 16 Orange, Stanislaus, Sonoma, Napa, Los Angeles, Riverside, San Bernardino, Santa Clara, San Francisco, Ventura, San Diego
Sharp Health Plan 2 San Diego
Stanford Health Care Advantage 2 Alameda, San Mateo, Santa Clara
UnitedHealthcare 17 Orange, San Diego, Kern, Santa Barbara, Los Angeles, San Luis Obispo, Riverside, San Bernardino, Ventura, San Mateo, Contra Costa, Stanislaus, Placer, Yolo, Santa Clara, Sacramento, Alameda, Madera, Amador, Tehama, Merced, Mendocino, Sonoma, Napa, Solano, San Joaquin, Shasta, Fresno, Nevada, Marin, Tulare, El Dorado, San Francisco, Lake, Kings, Santa Cruz
Vitality Health Plan 1 San Joaquin, Santa Clara
WellCare 4 Orange, Los Angeles, Riverside, San Bernardino, Ventura, San Joaquin
Western Health Advantage 2 Sonoma, Napa, Solano, Marin, Yolo, Sacramento

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California Medicare Advantage Plans by Company

We’ve put together a list of all of plans available from each CA Medicare company to help you compare Medicare Advantage plans by company in California. Take a look at the plans here.

Medicare Plans in California Offered by Clever Care Health Plan

Though plans can vary from county to county, Clever Care Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Clever Care Balance Medicare Advantage (HMO) H7607-003 Orange, San Diego, Los Angeles Local HMO $31.50
Clever Care Longevity Medicare Advantage (HMO) H7607-002 Orange, San Diego, Los Angeles Local HMO $0.00

Medicare Plans in California Offered by Health Net

Though plans can vary from county to county, Health Net offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Health Net Amber II (HMO D-SNP) H0562-121 Orange, San Diego, Kern, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, San Francisco Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Health Net Amber I (HMO D-SNP) H0562-055 Orange, San Diego, Kern, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, San Francisco Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Health Net Jade (HMO C-SNP) H0562-092 Orange, San Diego, Kern, Los Angeles, Fresno, San Francisco Local HMO $0.00
Health Net Amber II Premier (HMO D-SNP) H3561-001 Fresno, Sacramento Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in California Offered by Brand New Day

Though plans can vary from county to county, Brand New Day offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Brand New Day Bridges Care Plan (HMO C-SNP) H0838-028 Orange, San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, Santa Clara, San Francisco, Kings, Sacramento Local HMO $0.00
Brand New Day Select Choice I Plan (HMO I-SNP) H0838-044 Orange, Los Angeles, Riverside, San Bernardino Local HMO $31.50
Brand New Day Embrace Choice Plan (HMO C-SNP) H0838-040 Orange, San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, Santa Clara, San Francisco, Kings, Sacramento Local HMO $31.50
Brand New Day Harmony Choice Plan (HMO C-SNP) H0838-020 Orange, San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, Santa Clara, San Francisco, Kings, Sacramento Local HMO $31.50
Brand New Day Bridges Choice Plan (HMO C-SNP) H0838-029 Orange, San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, Santa Clara, San Francisco, Kings, Sacramento Local HMO $31.50
Brand New Day Classic Care I Plan (HMO) H0838-025 Orange, San Diego, Kern, Los Angeles, Riverside, San Bernardino Local HMO $0.00
Brand New Day Classic Choice Plan (HMO) H0838-033 Orange, San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, Santa Clara, San Francisco, Kings, Sacramento Local HMO $31.50
Brand New Day Classic Care II Plan (HMO) H0838-037 Orange, San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, Santa Clara, San Francisco, Kings, Sacramento Local HMO $0.00
Brand New Day Embrace Care Plan (HMO C-SNP) H0838-039 Orange, San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, Santa Clara, San Francisco, Kings, Sacramento Local HMO $0.00
Brand New Day Harmony Care Plan (HMO C-SNP) H0838-032 Orange, San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, Santa Clara, San Francisco, Kings, Sacramento Local HMO $0.00
Brand New Day Dual Access Plan (HMO D-SNP) H0838-024 Orange, Madera, Kern, Imperial, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, San Francisco, Kings, Sacramento Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Brand New Day Select Care I Plan (HMO I-SNP) H0838-042 Orange, Los Angeles, Riverside, San Bernardino Local HMO $0.00
Brand New Day Select Choice II Plan (HMO I-SNP) H0838-045 San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Fresno, Tulare, Santa Clara, San Francisco, Kings, Sacramento Local HMO $31.50
Brand New Day Select Care II Plan (HMO I-SNP) H0838-043 San Diego, San Mateo, Madera, Kern, Imperial, San Joaquin, Fresno, Tulare, Santa Clara, San Francisco, Kings, Sacramento Local HMO $0.00

Medicare Plans in California Offered by Blue Shield of California

Though plans can vary from county to county, Blue Shield of California offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Blue Shield AdvantageOptimum Plan (HMO) H5928-004 Orange, Stanislaus, Merced, San Joaquin, Los Angeles, Fresno, Santa Clara Local HMO $0.00
Blue Shield TotalDual Plan (HMO D-SNP) H5928-005 Orange, San Diego, Los Angeles, San Bernardino Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Blue Shield Vital (HMO) H0504-044 Orange, Los Angeles, Riverside, San Bernardino Local HMO $0.00
Blue Shield 65 Plus Plan 2 (HMO) H0504-021 Orange, Los Angeles Local HMO $0.00
Blue Shield Inspire (HMO) H0504-043 Orange, Alameda, San Mateo, Madera, Stanislaus, Merced, San Joaquin, Los Angeles, Fresno, Santa Clara, Sacramento Local HMO $0.00
Blue Shield 65 Plus (HMO) H0504-015 Orange, San Diego, Kern, Santa Barbara, Los Angeles, San Luis Obispo, Riverside, San Bernardino, Ventura Local HMO $0.00
Blue Shield Coordinated Choice Plan (HMO) H5928-037 Orange, San Diego, Stanislaus, Merced, San Joaquin, Los Angeles, Fresno, Riverside, San Bernardino, Santa Clara Local HMO $31.50
Blue Shield Inspire (PPO) H4937-001 Alameda Local PPO $98.00
Blue Shield AdvantageOptimum Plan 1 (HMO) H5928-010 San Diego Local HMO $0.00
Blue Shield AdvantageOptimum Plan 2 (HMO) H5928-053 San Diego Local HMO $0.00
Blue Shield Inspire (HMO D-SNP) H5928-054 Stanislaus, San Joaquin, Fresno Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Blue Shield 65 Plus Choice Plan (HMO) H0504-040 Riverside, San Bernardino Local HMO $0.00

Medicare Plans in California Offered by WellCare

Though plans can vary from county to county, WellCare offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
WellCare Dividend (HMO) H5087-025 Orange, Los Angeles, Riverside, San Bernardino, Ventura Local HMO $0.00
WellCare Best (HMO) H5087-005 Orange, San Joaquin, Los Angeles, Riverside, San Bernardino, Ventura Local HMO $0.00
WellCare Plus (HMO) H5087-002 Orange, San Joaquin, Los Angeles, Riverside, San Bernardino, Ventura Local HMO $4.60
WellCare Freedom (HMO D-SNP) H5087-001 Los Angeles Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in California Offered by Kaiser Permanente

Though plans can vary from county to county, Kaiser Permanente offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP) H0524-029 Orange, San Diego, Kern, Los Angeles, Riverside, San Bernardino, Ventura Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) H0524-003 Orange, Los Angeles Local HMO $0.00
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) H0524-032 Alameda, Napa, San Francisco Local HMO $84.00
Senior Advantage Medicare Medi-Cal Plan North (HMO D-SNP) H0524-030 Alameda, Yuba, San Mateo, Madera, Contra Costa, Mariposa, Sutter, Stanislaus, Amador, Napa, Solano, Placer, San Joaquin, Santa Cruz, Fresno, Marin, Tulare, Yolo, El Dorado, Santa Clara, San Francisco, Kings, Sacramento Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Kaiser Permanente Senior Advantage Basic Alameda (HMO) H0524-059 Alameda Local HMO $24.00
Kaiser Permanente Senior Advantage San Diego (HMO) H0524-037 San Diego Local HMO $0.00
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) H0524-051 Yuba, Sutter, Amador, Sonoma, Placer, Yolo, El Dorado, Sacramento Local HMO $15.00
Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) H0524-013 Yuba, Sutter, Amador, Sonoma, Placer, Yolo, El Dorado, Sacramento Local HMO $75.00
Kaiser Permanente Senior Advantage Marin San Mateo (HMO) H0524-031 San Mateo, Marin Local HMO $89.00
Kaiser Permanente Senior Advantage Basic Fresno (HMO) H0524-046 Madera, Mariposa, Fresno, Tulare, Kings Local HMO $15.00
Kaiser Permanente Senior Advantage Enhanced Fresno (HMO) H0524-038 Madera, Mariposa, Fresno, Tulare, Kings Local HMO $75.00
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) H0524-035 Kern Local HMO $29.00
Kaiser Permanente Senior Advantage Basic Kern (HMO) H0524-036 Kern Local HMO $0.00
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) H0524-061 Contra Costa Local HMO $24.00
Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) H0524-033 Contra Costa Local HMO $84.00
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) H0524-040 Stanislaus Local HMO $75.00
Kaiser Permanente Senior Advantage Basic Stanis (HMO) H0524-041 Stanislaus Local HMO $15.00
Kaiser Permanente Senior Advantage Solano (HMO) H0524-008 Solano Local HMO $89.00
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) H0524-043 San Joaquin Local HMO $15.00
Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) H0524-042 San Joaquin Local HMO $75.00
Kaiser Permanente Senior Advantage Santa Cruz (HMO) H0524-054 Santa Cruz Local HMO $79.00
Kaiser Permanente Senior Advantage Inland Empire (HMO) H0524-015 Riverside, San Bernardino Local HMO $0.00
Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) H0524-039 Santa Clara Local HMO $75.00
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) H0524-062 Santa Clara Local HMO $15.00
Kaiser Permanente Senior Advantage Basic SF (HMO) H0524-060 San Francisco Local HMO $24.00
Kaiser Permanente Senior Advantage Ventura (HMO) H0524-034 Ventura Local HMO $0.00

Medicare Plans in California Offered by HEALTH NET COMMUNITY SOLUTIONS, INC

Though plans can vary from county to county, HEALTH NET COMMUNITY SOLUTIONS, INC offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Health Net Sapphire Premier II (HMO) H3561-005 Orange, Alameda, San Diego, Kern, Imperial, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, San Francisco Local HMO $26.70
Health Net Sapphire Premier (HMO) H3561-002 Orange, Alameda, San Diego, Kern, Imperial, Los Angeles, Fresno, Tulare, Riverside, San Bernardino, San Francisco Local HMO $25.40

Medicare Plans in California Offered by Anthem Blue Cross

Though plans can vary from county to county, Anthem Blue Cross offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Anthem MediBlue Plus (HMO) H0544-061 Orange, Alameda, San Diego, San Mateo, Madera, Kern, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, Yolo, San Bernardino, Santa Clara, San Francisco, Ventura, Kings, Sacramento Local HMO $0.00
Anthem MediBlue Select (HMO) H0544-059 Orange, San Diego, Los Angeles, Riverside, San Bernardino, San Francisco Local HMO $0.00
Anthem MediBlue StartSmart Plus (HMO) H0544-007 Orange, Stanislaus, Los Angeles, San Bernardino, Santa Clara, San Benito Local HMO $0.00
Anthem MediBlue Value Plus (HMO) H0544-002 Orange, Stanislaus, Los Angeles, San Bernardino, Santa Clara, San Benito Local HMO $0.00
Anthem MediBlue Coordination Plus (HMO) H0544-072 Orange, Alameda, San Diego, San Mateo, Los Angeles, Riverside, San Bernardino, Santa Clara Local HMO $12.20
Anthem MediBlue Connect Plus (HMO) H0544-122 Orange, Stanislaus, Los Angeles, San Bernardino, Santa Clara, San Benito Local HMO $23.50
Anthem MediBlue Extra (HMO) H0544-081 Orange, San Diego, Los Angeles, Riverside, San Bernardino Local HMO $31.50
Anthem MediBlue Value (HMO) H0544-107 Stanislaus Local HMO $0.00

Medicare Plans in California Offered by Health Net of California

Though plans can vary from county to county, Health Net of California offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Health Net Gold Select (HMO) H0562-125 Orange, Los Angeles, Riverside, San Bernardino Local HMO $0.00
Health Net Sapphire (HMO) H0562-122 Orange, San Diego, Kern, Stanislaus, Los Angeles, Riverside, San Bernardino, Santa Clara Local HMO $28.50
Health Net Healthy Heart (HMO) H0562-123 Orange, Alameda, San Diego, Stanislaus, Placer, Imperial, Los Angeles, Fresno, Riverside, Yolo, San Bernardino, San Francisco, Sacramento Local HMO $17.00
Health Net Green (HMO) H0562-044 Alameda, Stanislaus, Placer, Los Angeles, Riverside, San Bernardino, Sacramento Local HMO * $0.00
Health Net Ruby Select (HMO) H0562-113 Alameda, Placer, Fresno, Yolo, San Francisco, Sacramento Local HMO $0.00
Health Net Ruby (HMO) H0562-079 Kern, Stanislaus, Santa Clara Local HMO $0.00

Medicare Plans in California Offered by SCAN Health Plan

Though plans can vary from county to county, SCAN Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
SCAN Balance (HMO C-SNP) H5425-034 Orange, Stanislaus, Sonoma, Napa, Los Angeles Local HMO $0.00
SCAN Plus (HMO) H5425-045 Orange, Stanislaus, Los Angeles, Riverside, San Bernardino, Santa Clara, San Francisco, Ventura Local HMO $31.50
SCAN Healthy at Home (HMO I-SNP) H9104-006 Orange, Los Angeles, Riverside, San Bernardino Local HMO $0.00
SCAN Classic (HMO) H5425-007 Orange, Stanislaus, Sonoma, Napa, Los Angeles, Riverside, San Bernardino, Santa Clara, San Francisco, Ventura Local HMO $0.00
SCAN Prime (HMO) H5425-066 Orange, Los Angeles, Riverside, San Bernardino Local HMO $26.00
SCAN Heart First (HMO C-SNP) H5425-028 Orange, Sonoma, Napa, Riverside, San Bernardino Local HMO $0.00
Scripps Heart First offered by SCAN Health Plan (HMO C-SNP) H5425-055 San Diego Local HMO $26.00
Scripps Plus offered by SCAN Health Plan (HMO) H5425-040 San Diego Local HMO $31.50
Scripps Signature offered by SCAN Health Plan (HMO) H5425-004 San Diego Local HMO $74.00
Scripps Classic offered by SCAN Health Plan (HMO) H5425-005 San Diego Local HMO $0.00
SCAN Compass (HMO) H5425-074 Sonoma, Napa Local HMO $25.00
VillageHealth (HMO-POS C-SNP) H5943-002 Los Angeles, Riverside, San Bernardino Local HMO $31.50
SCAN Connections at Home (HMO D-SNP) H5425-030 Los Angeles, Riverside, San Bernardino Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
SCAN Connections (HMO D-SNP) H5425-010 Los Angeles, Riverside, San Bernardino Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
SCAN Classic II (HMO) H5425-064 Los Angeles Local HMO $59.00
SCAN Options (HMO) H5425-073 Santa Clara Local HMO $0.00

Medicare Plans in California Offered by Golden State

Though plans can vary from county to county, Golden State offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Connected Care (HMO) H2241-013 Orange, San Diego, Stanislaus, San Joaquin, Los Angeles, San Luis Obispo, Riverside, San Bernardino Local HMO $0.00
Golden State Senior Health Plan (HMO) H2241-014 San Francisco Local HMO $0.00

Medicare Plans in California Offered by Aetna Medicare

Though plans can vary from county to county, Aetna Medicare offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Aetna Medicare Choice Plan (PPO) H5521-056 Orange, San Diego, Kern, Los Angeles, Fresno, Ventura Local PPO $89.00
Aetna Medicare Prime Plan (HMO) H0523-061 Orange, Los Angeles, San Bernardino Local HMO $0.00
Aetna Medicare Plus Plan (HMO) H4982-001 Orange, Alameda, San Diego, Kern, Los Angeles, Fresno, Marin, Riverside, San Bernardino, Santa Clara, San Francisco, Ventura Local HMO $0.00
Aetna Medicare Select Plan (HMO) H0523-002 Orange, San Diego, Kern, Los Angeles, Riverside, San Bernardino Local HMO $0.00
Aetna Medicare Eagle Plan (HMO) H4982-013 Orange, Alameda, San Diego, Kern, Los Angeles, Fresno, Marin, Riverside, San Bernardino, Santa Clara, San Francisco, Ventura Local HMO * $0.00
Aetna Medicare Elite Plan (PPO) H5521-293 Alameda, Stanislaus, Placer, San Joaquin, Marin, Yolo, Santa Clara, San Francisco, Sacramento Local PPO $0.00
Aetna Medicare Plus Plan 2 (HMO) H4982-015 San Diego Local HMO $21.00

Medicare Plans in California Offered by Imperial Health Plan of California

Though plans can vary from county to county, Imperial Health Plan of California offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Imperial Senior Value (HMO C-SNP) H5496-005 Orange, Alameda, San Diego, San Mateo, Madera, Kern, Contra Costa, Stanislaus, Merced, Santa Barbara, Placer, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, Yolo, San Bernardino, Santa Clara, San Francisco, Ventura, Kings, Sacramento Local HMO $0.00
Imperial Dual Plan (HMO D-SNP) H5496-011 San Francisco, Sacramento Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in California Offered by Humana

Though plans can vary from county to county, Humana offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Humana Value Plus H5619-037 (HMO) H5619-037 Orange, San Diego, Los Angeles, Riverside, San Bernardino Local HMO $20.40
Humana Gold Plus H5619-021 (HMO) H5619-021 Orange, Los Angeles Local HMO $0.00
Humana Honor (HMO) H5619-120 Orange, San Diego, Kern, Los Angeles, Riverside, San Bernardino, Ventura Local HMO * $0.00
Humana Gold Plus H5619-016 (HMO) H5619-016 San Diego Local HMO $0.00
UC San Diego Health Humana (HMO) H5619-131 San Diego Local HMO $0.00
Humana Gold Plus H5619-013 (HMO) H5619-013 Madera Local HMO $0.00
Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) H5619-038 Madera, Kern, Stanislaus, San Joaquin, Fresno, San Luis Obispo, Tulare, Ventura, Kings Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Humana Gold Plus H5619-116 (HMO) H5619-116 Kern Local HMO $0.00
Humana Gold Plus H5619-029 (HMO) H5619-029 Contra Costa Local HMO $70.00
Humana Gold Plus H5619-032 (HMO) H5619-032 Stanislaus Local HMO $0.00
Humana Gold Plus H5619-130 (HMO) H5619-130 Santa Barbara, Ventura Local HMO $49.00
Humana Gold Plus H5619-026 (HMO) H5619-026 San Joaquin Local HMO $91.00
Humana Community (HMO) H7621-003 San Joaquin, Riverside Local HMO $0.00
Humana Gold Plus H5619-012 (HMO) H5619-012 Fresno Local HMO $0.00
Humana Gold Plus H5619-119 (HMO) H5619-119 San Luis Obispo Local HMO $0.00
Humana Gold Plus H5619-015 (HMO) H5619-015 Tulare, Kings Local HMO $0.00
Humana Gold Plus H5619-039 (HMO) H5619-039 Riverside, San Bernardino Local HMO $0.00

Medicare Plans in California Offered by Imperial Health Plan of California, Inc

Though plans can vary from county to county, Imperial Health Plan of California, Inc offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Imperial Traditional (HMO) H5496-007 Orange, Alameda, San Diego, San Mateo, Madera, Kern, Contra Costa, Stanislaus, Merced, Santa Barbara, Placer, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, Yolo, San Bernardino, Santa Clara, San Francisco, Ventura, Kings, Sacramento Local HMO $0.00
Imperial Traditional Plus (HMO) H5496-009 Orange, Alameda, San Diego, San Mateo, Madera, Kern, Contra Costa, Stanislaus, Merced, Santa Barbara, Placer, San Joaquin, Los Angeles, Fresno, Tulare, Riverside, Yolo, San Bernardino, Santa Clara, San Francisco, Ventura, Kings, Sacramento Local HMO $31.50
Imperial Dynamic Plan (HMO) H5496-012 Orange, San Diego, Kern, Los Angeles, Riverside, San Bernardino, Ventura, Sacramento Local HMO $0.00

Medicare Plans in California Offered by UnitedHealthcare

Though plans can vary from county to county, UnitedHealthcare offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
AARP Medicare Advantage Patriot (HMO) H0543-121 Orange, San Diego, Kern, Santa Barbara, Los Angeles, San Luis Obispo, Riverside, San Bernardino, Ventura Local HMO * $0.00
AARP Medicare Advantage SecureHorizons Focus (HMO) H0543-169 Orange, San Mateo, Contra Costa, Stanislaus, Placer, Los Angeles, Riverside, Yolo, San Bernardino, Santa Clara, Sacramento Local HMO $0.00
AARP Medicare Advantage SecureHorizons Premier (HMO) H0543-165 Orange, San Diego, Los Angeles, Riverside, San Bernardino Local HMO $28.20
AARP Medicare Advantage Freedom Plus (HMO-POS) H0543-215 Orange, Los Angeles, Riverside, San Bernardino Local HMO $0.00
AARP Medicare Advantage SecureHorizons Plan 2 (HMO) H0543-138 Orange, Stanislaus, Los Angeles, San Luis Obispo, Riverside, San Bernardino Local HMO $0.00
UnitedHealthcare Medicare Advantage Assure (HMO) H0543-153 Orange, Alameda, San Diego, Madera, Kern, Contra Costa, Stanislaus, Amador, Tehama, Merced, Mendocino, Sonoma, Napa, Solano, Placer, San Joaquin, Shasta, Los Angeles, Fresno, Nevada, Marin, Tulare, Riverside, Yolo, El Dorado, San Bernardino, Santa Clara, San Francisco, Lake, Kings, Sacramento Local HMO $22.50
UnitedHealthcare Canopy Health Medicare Advantage (HMO) H0543-188 Alameda, Contra Costa, Santa Cruz, Marin, San Francisco Local HMO $69.00
AARP Medicare Advantage SecureHorizons Plan 1 (HMO) H0543-070 Alameda, San Mateo, Contra Costa, Stanislaus, Santa Barbara, Los Angeles, San Luis Obispo Local HMO $110.00
UnitedHealthcare Dual Complete (HMO D-SNP) H1375-001 Alameda, Madera, Fresno, Kings Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
AARP Medicare Advantage SecureHorizons Plan 4 (HMO) H0543-152 San Diego Local HMO $0.00
AARP Medicare Advantage Walgreens (HMO) H0543-204 San Diego Local HMO $0.00
AARP Medicare Advantage SecureHorizons Value (HMO) H0543-013 San Diego Local HMO $25.00
Sharp SecureHorizons Plan by UnitedHealthcare (HMO) H0543-145 San Diego Local HMO $0.00
UnitedHealthcare Chronic Complete Focus (HMO C-SNP) H0543-214 San Diego Local HMO $0.00
AARP Medicare Advantage SecureHorizons (HMO) H0543-035 Madera, Kern, Amador, Tehama, Merced, Mendocino, Sonoma, Napa, Solano, Placer, San Joaquin, Shasta, Santa Cruz, Fresno, Nevada, Marin, Tulare, Yolo, El Dorado, Santa Clara, San Francisco, Ventura, Lake, Kings, Sacramento Local HMO $69.00
AARP Medicare Advantage Choice (PPO) H4829-003 Mendocino, Sonoma, Napa, Solano, Marin, Tulare, Lake Local PPO $75.00
Choice (HMO) H1426-001 San Joaquin, Santa Clara Local HMO $0.00

Medicare Plans in California Offered by Anthem

Though plans can vary from county to county, Anthem offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Anthem MediBlue Care On Site (HMO I-SNP) H0544-005 Orange, Stanislaus, Los Angeles, San Bernardino, Santa Clara Local HMO $0.00
Anthem MediBlue Lung Care (HMO C-SNP) H0544-014 Orange, Stanislaus, Los Angeles, San Bernardino, Santa Clara Local HMO $0.00
Anthem MediBlue Diabetes Care (HMO C-SNP) H0544-004 Orange, Stanislaus, Los Angeles, San Bernardino, Santa Clara Local HMO $0.00
Anthem MediBlue ESRD Care (HMO C-SNP) H0544-015 Orange, Los Angeles, San Bernardino Local HMO $0.00
Anthem MediBlue Heart Care (HMO C-SNP) H0544-013 Orange, Stanislaus, Los Angeles, San Bernardino, Santa Clara Local HMO $0.00
Anthem MediBlue ESRD Care (PPO C-SNP) H8552-028 San Diego, Madera, Kern, Stanislaus, Merced, San Joaquin, Monterey, Fresno, San Luis Obispo, Tulare, Ventura, Kings Local PPO $31.50
Anthem MediBlue Dual Access (PPO D-SNP) H8552-030 Yuba, Sutter, Tehama, Sonoma, Napa, Solano, Shasta, El Dorado, Butte Local PPO $0.00 for people who qualify for both Medicare and Medicaid.
Anthem MediBlue Dual Advantage (HMO D-SNP) H0544-052 Madera, Kern, San Joaquin, Fresno, Tulare, San Francisco, Ventura, Kings, Sacramento Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Anthem MediBlue Dual Plus (HMO D-SNP) H0544-087 Madera, Kern, Fresno, Tulare, San Francisco, Ventura, Kings, Sacramento Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Anthem MediBlue Diabetes (HMO C-SNP) H0544-032 Stanislaus, Santa Clara, San Benito Local HMO $59.00
Anthem MediBlue Heart (HMO C-SNP) H0544-036 Stanislaus, Santa Clara, San Benito Local HMO $59.00
Anthem MediBlue Lung (HMO C-SNP) H0544-031 Stanislaus, Santa Clara, San Benito Local HMO $59.00
Anthem MediBlue Connect (HMO D-SNP) H0544-003 Los Angeles, Santa Clara Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Anthem MediBlue Care To You (HMO I-SNP) H0544-093 Sacramento Local HMO $0.00
Anthem MediBlue Diabetes Care Plus (HMO C-SNP) H0544-094 Sacramento Local HMO $0.00

Medicare Plans in California Offered by Astiva Health

Though plans can vary from county to county, Astiva Health offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Astiva Health Value (HMO) H1993-002 Orange, San Diego Local HMO $31.50
Astiva Health Advantage (HMO) H1993-001 Orange, San Diego Local HMO $0.00

Medicare Plans in California Offered by Anthem Blue Cross Life and Health Insurance Co

Though plans can vary from county to county, Anthem Blue Cross Life and Health Insurance Co offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Anthem MediBlue Access (PPO) H8552-020 Orange, Yuba, Sutter, Tehama, Sonoma, Napa, Solano, Shasta, El Dorado, Butte Local PPO $172.00

Medicare Plans in California Offered by Alignment Health Plan

Though plans can vary from county to county, Alignment Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
AVA (HMO) H3815-027 Orange, San Diego, Los Angeles, San Luis Obispo, Santa Clara, Ventura Local HMO $0.00
Platinum (HMO) H3815-008 Orange, San Diego, San Joaquin, Los Angeles, Marin, Riverside, San Bernardino Local HMO $0.00
Heart & Diabetes (HMO C-SNP) H3815-010 Orange, Los Angeles Local HMO $0.00
My Choice (HMO) H3815-001 Orange, Stanislaus, San Joaquin, Los Angeles, San Luis Obispo, Riverside, San Bernardino, Santa Clara, San Francisco, Ventura Local HMO $0.00
CalPlus (HMO) H3815-009 Orange, San Diego, Stanislaus, San Joaquin, Los Angeles, San Luis Obispo, Marin, Riverside, San Bernardino, Santa Clara, San Francisco, Ventura Local HMO $20.10
Select (HMO) H3815-032 San Diego Local HMO $0.00
Harmony (HMO) H3815-031 San Diego, Santa Clara Local HMO $0.00
My Choice (PPO) H4961-002 San Mateo, Stanislaus, Sonoma, Placer, San Joaquin, Santa Cruz, Yolo, Sacramento Local PPO $95.00
Sutter Advantage (HMO) H3815-022 San Mateo, Sonoma, Placer, Santa Cruz, Yolo, Santa Clara, San Francisco, Sacramento Local HMO $46.00
Balance (PPO) H4961-006 Stanislaus, San Joaquin Local PPO $0.00
AllCare Preferred Plan (HMO) H3815-011 Stanislaus Local HMO $0.00
CalPlusDuals (HMO D-SNP) H3815-030 Stanislaus, San Joaquin, Marin Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
smartHMO (HMO) H3815-013 Los Angeles Local HMO $0.00

Medicare Plans in California Offered by OneCare

Though plans can vary from county to county, OneCare offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
OneCare (HMO D-SNP) H5433-001 Orange Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in California Offered by Central Health Medicare Plan

Though plans can vary from county to county, Central Health Medicare Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Central Health Premier Plan (HMO) H5649-004 Orange, Los Angeles, Riverside, San Bernardino Local HMO $31.50
Central Health Medicare Plan (HMO) H5649-001 Orange, Los Angeles, Riverside, San Bernardino Local HMO $0.00
Central Health Ventura Medicare Plan (HMO) H5649-008 Ventura Local HMO $0.00

Medicare Plans in California Offered by Inter Valley Health Plan

Though plans can vary from county to county, Inter Valley Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Inter Valley Health Plan Vitality Plus (HMO) H0545-015 Orange, Los Angeles, Riverside, San Bernardino Local HMO $31.50
Inter Valley Health Plan Service To Seniors (HMO) H0545-001 Orange, Los Angeles, Riverside, San Bernardino Local HMO $0.00
Inter Valley Health Plan Desert Preferred Choice (HMO) H0545-012 Riverside Local HMO $0.00

Medicare Plans in California Offered by Golden State Medicare Health Plan

Though plans can vary from county to county, Golden State Medicare Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Connected Care Select (HMO C-SNP) H2241-019 Orange, Stanislaus, Los Angeles, San Luis Obispo, Riverside Local HMO $0.00

Medicare Plans in California Offered by Central Health

Though plans can vary from county to county, Central Health offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Central Health Focus Plan (HMO C-SNP) H5649-006 Orange, Los Angeles, San Bernardino Local HMO $0.00
Central Health Medi-Medi Plan (HMO D-SNP) H5649-002 Los Angeles, San Bernardino Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Central Health Ventura Medi-Medi Plan (HMO D-SNP) H5649-009 Ventura Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in California Offered by Stanford Health Care Advantage

Though plans can vary from county to county, Stanford Health Care Advantage offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Stanford Health Care Advantage – Gold (HMO) H2986-007 Alameda, San Mateo, Santa Clara Local HMO $69.00
Stanford Health Care Advantage – Platinum (HMO) H2986-004 Alameda, San Mateo, Santa Clara Local HMO $99.00

Medicare Plans in California Offered by Aetna

Though plans can vary from county to county, Aetna offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Aetna Medicare Preferred Plan (HMO D-SNP) H4982-008 Alameda, Kern, Fresno, Marin, San Francisco, Ventura Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in California Offered by Sharp Health Plan

Though plans can vary from county to county, Sharp Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Sharp Direct Advantage Gold Card (HMO) H5386-003 San Diego Local HMO $0.00
Sharp Direct Advantage Platinum Card (HMO) H5386-004 San Diego Local HMO $58.00

Medicare Plans in California Offered by Molina Healthcare

Though plans can vary from county to county, Molina Healthcare offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Molina Medicare Complete Care (HMO D-SNP) H5810-001 San Diego, Imperial, Los Angeles, Riverside, San Bernardino Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in California Offered by Chinese Community Health Plan

Though plans can vary from county to county, Chinese Community Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
CCHP Senior Value Program (HMO) H0571-007 San Mateo, San Francisco Local HMO $0.00
CCHP Senior Program (HMO) H0571-001 San Mateo, San Francisco Local HMO $42.00

Medicare Plans in California Offered by Western Health Advantage

Though plans can vary from county to county, Western Health Advantage offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Western Health Advantage MyCare Plus (HMO) H2782-003 Sonoma, Napa, Solano, Marin, Yolo, Sacramento Local HMO $99.00
Western Health Advantage MyCare (HMO) H2782-002 Sonoma, Napa, Solano, Marin, Yolo, Sacramento Local HMO $0.00

Medicare Plans in California Offered by Vitality Health Plan

Though plans can vary from county to county, Vitality Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Plus (HMO) H1426-003 San Joaquin, Santa Clara Local HMO $31.50

Medicare Plans in California Offered by Aspire Health Plan

Though plans can vary from county to county, Aspire Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Aspire Health Advantage (HMO) H8764-001 Monterey Local HMO $139.00
Aspire Health Value (HMO) H8764-003 Monterey Local HMO $52.00
Aspire Health Plus (HMO-POS) H8764-002 Monterey Local HMO $269.00

Medicare Plans in California Offered by Brandman Health Plan

Though plans can vary from county to county, Brandman Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Brandman Health Plan (Aspire) (HMO C-SNP) H7594-003 Los Angeles Local HMO $0.00
Brandman Health Plan (Aspire-D) (HMO C-SNP) H7594-004 Los Angeles Local HMO $31.50
Brandman Health Plan (Arise) (HMO C-SNP) H7594-001 Los Angeles Local HMO $0.00
Brandman Health Plan (Arise-D) (HMO C-SNP) H7594-002 Los Angeles Local HMO $31.50

Medicare Plans in California Offered by AHF

Though plans can vary from county to county, AHF offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
PHP (HMO C-SNP) H5852-001 Los Angeles Local HMO $0.00

Medicare Plans in California Offered by CCHP Health Plan

Though plans can vary from county to county, CCHP Health Plan offers these Medicare plans in California.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
CCHP Senior Select Program (HMO D-SNP) H0571-005 San Francisco Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

California Medicare Advantage Plans With No Additional Cost

If you decide to get Medicare Advantage in California, you still have to pay your original Medicare Part B premium. Many CA Medicare companies offer Advantage plans that don’t cost any more than your original Medicare premium. Take a look at your options.

Zero-Cost {?{?state}} Medicare Advantage Plans

Plan Name County Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
AARP Medicare Advantage Freedom Plus (HMO-POS) – H0543-216-0 San Benito Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,000
AARP Medicare Advantage Patriot (HMO) – H0543-121-0 San Joaquin This Plan does NOT include prescription drug coverage. $4,900
AARP Medicare Advantage SecureHorizons Focus (HMO) – H0543-170-0 Contra Costa Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,000
AARP Medicare Advantage SecureHorizons Plan 2 (HMO) – H0543-144-0 San Joaquin Preferred Generic: $0.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,900
Aetna Medicare Eagle Plan (HMO) – H4982-013-0 San Benito This Plan does NOT include prescription drug coverage. $4,200
Aetna Medicare Plus Plan (HMO) – H4982-002-0 San Benito Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $37.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $999
Aetna Medicare Prime Plan (HMO) – H0523-061-0 Contra Costa Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $2,200
Aetna Medicare Select Plan (HMO) – H0523-022-0 Contra Costa Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,400
Anthem MediBlue Care On Site (HMO I-SNP) – H0544-005-0 Contra Costa Preferred Generic: $0.00, Generic: $9.50, Preferred Brand: $37.50, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Diabetes Care (HMO C-SNP) – H0544-010-0 Contra Costa Preferred Generic: $0.00, Generic: $9.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue ESRD Care (HMO C-SNP) – H0544-020-0 San Joaquin Preferred Generic: $0.00, Generic: $9.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Heart Care (HMO C-SNP) – H0544-038-0 San Joaquin Preferred Generic: $0.00, Generic: $9.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Lung Care (HMO C-SNP) – H0544-019-0 Sonoma Preferred Generic: $0.00, Generic: $9.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Plus (HMO) – H0544-060-3 Stanislaus Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $5,000
Anthem MediBlue Select (HMO) – H0544-066-0 Sonoma Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $1,800
Anthem MediBlue StartSmart Plus (HMO) – H0544-007-0 San Joaquin Preferred Generic: $5.00, Generic: $14.50, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $10.00 $3,000
Anthem MediBlue Value Plus (HMO) – H0544-008-0 Kern Preferred Generic: $0.00, Generic: $9.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $1,900
Blue Shield 65 Plus (HMO) – H0504-017-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $2,799
Blue Shield 65 Plus Choice Plan (HMO) – H0504-040-0 Santa Clara Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $35.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $999
Blue Shield Vital (HMO) – H0504-045-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Brand New Day Bridges Care Plan (HMO C-SNP) – H0838-028-0 San Joaquin Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $45.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Brand New Day Classic Care I Plan (HMO) – H0838-025-0 Kern Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $999
Brand New Day Classic Care II Plan (HMO) – H0838-037-0 Kern Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30%, Select Care Drugs: $0.00 $999
Brand New Day Embrace Care Plan (HMO C-SNP) – H0838-039-1 Santa Clara, San Francisco Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Brand New Day Harmony Care Plan (HMO C-SNP) – H0838-032-0 Kern Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Brand: $90.00, Specialty Tier: 30%, Select Care Drugs: $0.00 N/A
Brand New Day Select Care I Plan (HMO I-SNP) – H0838-042-0 Santa Clara Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Central Health Focus Plan (HMO C-SNP) – H5649-006-0 Santa Clara Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $35.00, Non-Preferred Drug: $75.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Central Health Medicare Plan (HMO) – H5649-001-0 Santa Clara Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $35.00, Non-Preferred Drug: $75.00, Specialty Tier: 33%, Select Care Drugs: $10.00 $1,800
Connected Care (HMO) – H2241-016-0 Stanislaus Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $2,000
Health Net Gold Select (HMO) – H0562-126-0 Ventura Preferred Generic: $0.00, Generic: $1.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $850
Health Net Green (HMO) – H0562-044-0 Fresno, Stanislaus, San Joaquin This Plan does NOT include prescription drug coverage. $3,400
Humana Gold Plus H5619-039 (HMO) – H5619-039-2 Sacramento Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,499
Humana Honor (HMO) – H5619-121-0 Orange This Plan does NOT include prescription drug coverage. $6,700
IEHP DualChoice (Medicare-Medicaid Plan) – H5355-001-0 San Francisco Tier 1: 0%, Tier 2: 0%, Tier 3: 0% N/A
Imperial Dynamic Plan (HMO) – H5496-012-0 San Francisco, Sacramento Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $30.00, Non-Preferred Drug: $75.00, Specialty Tier: 33% $899
Imperial Senior Value (HMO C-SNP) – H5496-005-0 Stanislaus Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $45.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $3.00 N/A
Imperial Traditional (HMO) – H5496-007-0 San Joaquin Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $45.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% $2,999
Inter Valley Health Plan Service To Seniors (HMO) – H0545-001-0 San Joaquin Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: 25%, Specialty Tier: 33%, Select Diabetic Drugs: $11.00 $1,000
Kaiser Permanente Senior Advantage Inland Empire (HMO) – H0524-015-0 San Joaquin Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Brand: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $3,400
Molina Dual Options (Medicare-Medicaid Plan) – H8677-001-0 Stanislaus Tier 1: 0%, Tier 2: 0%, Tier 3: 0% N/A
My Choice (HMO) – H3815-001-0 San Joaquin Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $30.00, Non-Preferred Drug: $100.00, Specialty Tier: 33%, Select Care Drugs: $3.00 $2,400
Platinum (HMO) – H3815-015-0 Kern Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $30.00, Non-Preferred Drug: $100.00, Specialty Tier: 33%, Select Care Drugs: $3.00 $2,400
SCAN Classic (HMO) – H5425-009-0 San Francisco Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $37.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $999
SCAN Healthy at Home (HMO I-SNP) – H9104-006-0 Santa Clara Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% N/A
SCAN Heart First (HMO C-SNP) – H5425-033-0 San Francisco Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $37.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% N/A
WellCare Best (HMO) – H5087-016-0 Santa Clara Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $1,000
WellCare Dividend (HMO) – H5087-025-0 Orange Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $2,900
Health Net Amber II (HMO D-SNP) – H0562-121-0 San Bernardino, Los Angeles (Partial), Los Angeles, Riverside, San Diego, Los Angeles (Partial), Los Angeles, Fresno, San Francisco, Orange, Kern, Tulare Preferred Generic: $0.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 46%, Specialty Tier: 25% N/A
Health Net Amber I (HMO D-SNP) – H0562-055-0 San Bernardino, Los Angeles (Partial), Los Angeles, Riverside, San Diego, Los Angeles (Partial), Los Angeles, Fresno, San Francisco, Orange, Kern, Tulare Preferred Generic: $0.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 41%, Specialty Tier: 25% N/A
Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP) – H0524-029-0 San Bernardino, Los Angeles (Partial), Los Angeles, Riverside, San Diego, Los Angeles (Partial), Los Angeles, Ventura, Orange, Kern Tier 1: 15%, Tier 2: 15%, Tier 3: 15%, Tier 4: 15%, Tier 5: 15%, Tier 6: 15% N/A
Blue Shield TotalDual Plan (HMO D-SNP) – H5928-005-0 San Diego Preferred Generic: $0.00, Generic: 25%, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25% N/A
Brand New Day Dual Access Plan (HMO D-SNP) – H0838-024-0 San Diego Preferred Generic: 0%, Generic: 25%, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25%, Select Care Drugs: 0% N/A
Central Health Medi-Medi Plan (HMO D-SNP) – H5649-002-0 San Diego Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25%, Select Care Drugs: $10.00 N/A
Molina Medicare Complete Care (HMO D-SNP) – H5810-001-0 San Bernardino, Los Angeles, Los Angeles (Partial), Riverside, San Diego, Los Angeles, Los Angeles (Partial) Preferred Generic: $0.00, Generic: $14.00, Preferred Brand: $40.00, Non-Preferred Drug: 29%, Specialty Tier: 25% N/A
SCAN Connections (HMO D-SNP) – H5425-010-0 Los Angeles (Partial), Los Angeles, Los Angeles (Partial), Los Angeles, Orange, Kern Preferred Generic: $0.00, Generic: 25%, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25% N/A
SCAN Connections at Home (HMO D-SNP) – H5425-030-0 San Bernardino, Los Angeles, Los Angeles (Partial), Riverside, Los Angeles, Los Angeles (Partial) Preferred Generic: $0.00, Generic: 25%, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25% N/A
Senior Advantage Medicare Medi-Cal Plan North (HMO D-SNP) – H0524-030-0 Contra Costa Tier 1: 15%, Tier 2: 15%, Tier 3: 15%, Tier 4: 15%, Tier 5: 15%, Tier 6: 15% N/A
Aetna Medicare Elite Plan (PPO) – H5521-293-0 San Benito Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,550
Anthem MediBlue Plus (HMO) – H0544-074-0 San Joaquin Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $7,550
Health Net Ruby Select (HMO) – H0562-103-0 Contra Costa Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $4,500
Western Health Advantage MyCare (HMO) – H2782-002-0 San Benito Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $40.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,000
Anthem MediBlue Plus (HMO) – H0544-096-0 San Benito Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $4,900
Brand New Day Embrace Care Plan (HMO C-SNP) – H0838-039-2 San Joaquin Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Brand New Day Select Care II Plan (HMO I-SNP) – H0838-043-0 San Benito Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan) – H7885-001-0 Contra Costa Tier 1: 0%, Tier 2: 0%, Tier 3: 0% N/A
CCHP Senior Value Program (HMO) – H0571-007-0 Contra Costa Preferred Generic: $5.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Brand: $100.00, Specialty Tier: 31% $7,550
Blue Shield 65 Plus (HMO) – H0504-039-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,000
AARP Medicare Advantage Freedom Plus (HMO-POS) – H0543-210-0 San Benito Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,000
AARP Medicare Advantage SecureHorizons Focus (HMO) – H0543-168-0 San Benito Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,000
AARP Medicare Advantage SecureHorizons Plan 1 (HMO) – H0543-001-0 Contra Costa Preferred Generic: $2.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,400
AARP Medicare Advantage SecureHorizons Plan 2 (HMO) – H0543-151-0 Contra Costa Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,000
Aetna Medicare Plus Plan (HMO) – H4982-001-0 Sonoma Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $37.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $999
Aetna Medicare Select Plan (HMO) – H0523-002-0 Kern Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $2,000
Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan) – H6229-005-0 Santa Clara Tier 1: 0%, Tier 2: 0%, Tier 3: 0%, Tier 4: 0% N/A
Anthem MediBlue Diabetes Care (HMO C-SNP) – H0544-004-0 Kern Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $37.50, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue ESRD Care (HMO C-SNP) – H0544-015-0 Santa Clara, San Francisco Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $37.50, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Heart Care (HMO C-SNP) – H0544-013-0 Santa Clara Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $37.50, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Lung Care (HMO C-SNP) – H0544-014-0 Santa Clara Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $37.50, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Plus (HMO) – H0544-061-0 Ventura Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $7,550
Anthem MediBlue Select (HMO) – H0544-058-0 Sacramento Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $900
Anthem MediBlue Value Plus (HMO) – H0544-002-0 Stanislaus Preferred Generic: $0.00, Generic: $9.50, Preferred Brand: $37.50, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $900
AVA (HMO) – H3815-027-0 San Joaquin Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 33%, Select Care Drugs: $3.00 $999
Blue Shield 65 Plus (HMO) – H0504-015-0 Stanislaus Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $38.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $999
Blue Shield 65 Plus Plan 2 (HMO) – H0504-021-0 Kern Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $1,899
Blue Shield AdvantageOptimum Plan (HMO) – H5928-004-0 Santa Clara Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $999
Blue Shield Inspire (HMO) – H0504-043-0 Santa Clara Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $35.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $999
Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan) – H0148-002-0 Santa Clara Tier 1: 0%, Tier 2: 0%, Tier 3: 0%, Tier 4: 0% N/A
Blue Shield Vital (HMO) – H0504-044-0 Santa Clara Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Brandman Health Plan (Arise) (HMO C-SNP) – H7594-001-0 Orange Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Brandman Health Plan (Aspire) (HMO C-SNP) – H7594-003-0 Los Angeles, Los Angeles Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $45.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Clever Care Longevity Medicare Advantage (HMO) – H7607-002-1 San Diego Preferred Generic: 0%, Generic: $5.00, Preferred Brand: $35.00, Non-Preferred Brand: $75.00, Specialty Tier: 33%, Supplemental Drugs: $10.00 $2,999
Connected Care (HMO) – H2241-012-0 San Diego Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $1,499
Connected Care Select (HMO C-SNP) – H2241-018-0 Orange Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) – H3237-001-0 San Diego Tier 1: 0%, Tier 2: 0%, Tier 3: 0% N/A
Health Net Gold Select (HMO) – H0562-125-0 Los Angeles (Partial), Los Angeles, Los Angeles (Partial), Los Angeles, Orange Preferred Generic: $0.00, Generic: $1.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $850
Health Net Jade (HMO C-SNP) – H0562-092-0 Los Angeles (Partial), Los Angeles, Los Angeles (Partial), Los Angeles, Orange, Kern Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Heart & Diabetes (HMO C-SNP) – H3815-010-0 Los Angeles, Los Angeles (Partial), Los Angeles, Los Angeles (Partial), Orange Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $30.00, Non-Preferred Drug: $75.00, Specialty Tier: 33%, Select Care Drugs: $5.00 N/A
Humana Gold Plus H5619-021 (HMO) – H5619-021-0 Orange Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $35.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,000
Humana Honor (HMO) – H5619-120-0 Los Angeles (Partial), Los Angeles, San Diego, Los Angeles (Partial), Los Angeles, Orange This Plan does NOT include prescription drug coverage. $6,700
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) – H0524-003-0 Los Angeles (Partial), Los Angeles, Los Angeles (Partial), Los Angeles, Orange Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Brand: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $3,400
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan) – H8258-001-0 Los Angeles, Los Angeles Tier 1: 0%, Tier 2: 0%, Tier 3: 0%, Tier 4: 0% N/A
Molina Dual Options (Medicare-Medicaid Plan) – H8677-002-0 Los Angeles, Los Angeles Tier 1: 0%, Tier 2: 0%, Tier 3: 0% N/A
PHP (HMO C-SNP) – H5852-001-0 Los Angeles, Los Angeles (Partial), Los Angeles, Los Angeles (Partial) Generic: 15%, Preferred Brand: 15%, Non-Preferred Brand: 25%, Specialty Tier: 25%, Select Care Drugs: 0% N/A
Platinum (HMO) – H3815-008-0 Los Angeles, Los Angeles (Partial), Los Angeles, Los Angeles (Partial), Orange Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $30.00, Non-Preferred Drug: $75.00, Specialty Tier: 33%, Select Care Drugs: $5.00 $800
SCAN Balance (HMO C-SNP) – H5425-034-0 Los Angeles, Los Angeles (Partial), Los Angeles, Los Angeles (Partial), Orange Preferred Generic: $0.00, Generic: $2.00, Preferred Brand: $30.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% N/A
SCAN Classic (HMO) – H5425-006-0 Los Angeles, Los Angeles (Partial), Los Angeles, Los Angeles (Partial) Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $37.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $799
smartHMO (HMO) – H3815-013-0 Los Angeles, Los Angeles (Partial), Los Angeles, Los Angeles (Partial) Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $30.00, Non-Preferred Drug: $100.00, Specialty Tier: 33%, Select Care Drugs: $5.00 $3,400
WellCare Best (HMO) – H5087-005-0 Los Angeles, Los Angeles (Partial), Los Angeles, Los Angeles (Partial), Orange Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $25.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $1,000
WellCare Freedom (HMO D-SNP) – H5087-001-0 Los Angeles, Los Angeles (Partial), Los Angeles, Los Angeles (Partial) Preferred Generic: $0.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 45%, Specialty Tier: 25% N/A
Anthem MediBlue Connect (HMO D-SNP) – H0544-003-0 Los Angeles (Partial), Los Angeles, Los Angeles (Partial), Los Angeles, Santa Clara Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Plus (HMO) – H0544-060-4 Contra Costa Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $6,700
Anthem MediBlue Select (HMO) – H0544-067-0 Contra Costa Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $1,800
Blue Shield 65 Plus (HMO) – H0504-026-0 Contra Costa Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $2,799
Connected Care (HMO) – H2241-013-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $1,499
Connected Care Select (HMO C-SNP) – H2241-019-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Humana Community (HMO) – H7621-002-0 Santa Clara, San Francisco Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,500
Humana Gold Plus H5619-039 (HMO) – H5619-039-1 Kern Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,450
Inter Valley Health Plan Desert Preferred Choice (HMO) – H0545-012-0 Fresno, Stanislaus, San Joaquin Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: 30%, Specialty Tier: 33%, Select Diabetic Drugs: $11.00 $1,500
SCAN Classic (HMO) – H5425-008-0 San Joaquin Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $37.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $999
Anthem MediBlue Dual Access (PPO D-SNP) – H8552-030-0 Contra Costa Preferred Generic: $0.00, Generic: $4.00, Preferred Brand: $36.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 N/A
Aetna Medicare Plus Plan (HMO) – H4982-011-0 Contra Costa Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $42.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $4,900
CalPlusDuals (HMO D-SNP) – H3815-030-0 San Benito Preferred Generic: $0.00, Generic: $14.00, Preferred Brand: 23%, Non-Preferred Drug: 23%, Specialty Tier: 25%, Select Care Drugs: $5.00 N/A
Aetna Medicare Preferred Plan (HMO D-SNP) – H4982-008-0 Contra Costa Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% N/A
AARP Medicare Advantage SecureHorizons Plan 4 (HMO) – H0543-152-0 San Joaquin Preferred Generic: $5.00, Generic: $11.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 32% $3,400
AARP Medicare Advantage Walgreens (HMO) – H0543-204-0 Contra Costa Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $2,900
Aetna Medicare Plus Plan (HMO) – H4982-004-0 San Benito Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $37.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $2,000
Aetna Medicare Select Plan (HMO) – H0523-052-0 San Benito Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,400
Anthem MediBlue Plus (HMO) – H0544-065-0 Contra Costa Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,400
Anthem MediBlue Select (HMO) – H0544-091-0 Contra Costa Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $2,500
Astiva Health Advantage (HMO) – H1993-003-0 Contra Costa Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $32.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,000
Blue Shield 65 Plus (HMO) – H0504-028-0 San Joaquin Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,399
Blue Shield AdvantageOptimum Plan 1 (HMO) – H5928-010-0 San Joaquin Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Blue Shield AdvantageOptimum Plan 2 (HMO) – H5928-053-0 Sonoma Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan) – H0148-001-0 Stanislaus Tier 1: 0%, Tier 2: 0%, Tier 3: 0%, Tier 4: 0% N/A
Clever Care Longevity Medicare Advantage (HMO) – H7607-002-3 San Joaquin Preferred Generic: 0%, Generic: $5.00, Preferred Brand: $35.00, Non-Preferred Brand: $75.00, Specialty Tier: 33%, Supplemental Drugs: $10.00 $2,999
CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) – H5172-002-0 Kern Tier 1: 0%, Tier 2: 0%, Tier 3: 0%, Tier 4: 0% N/A
Connected Care (HMO) – H2241-017-0 Kern Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,000
Harmony (HMO) – H3815-031-0 Santa Clara, San Francisco Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 33%, Select Care Drugs: $3.00 $2,900
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) – H3237-002-0 Kern Tier 1: 0%, Tier 2: 0%, Tier 3: 0% N/A
Health Net Healthy Heart (HMO) – H0562-012-0 Santa Clara Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,000
Health Net Jade (HMO C-SNP) – H0562-114-0 Santa Clara Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Humana Gold Plus H5619-016 (HMO) – H5619-016-0 Santa Clara Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,200
Kaiser Permanente Senior Advantage San Diego (HMO) – H0524-037-0 Orange Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Brand: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $4,000
Platinum (HMO) – H3815-016-0 San Francisco, Sacramento Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $30.00, Non-Preferred Drug: $75.00, Specialty Tier: 33%, Select Care Drugs: $5.00 $2,900
Scripps Classic offered by SCAN Health Plan (HMO) – H5425-005-0 Stanislaus Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Select (HMO) – H3815-032-0 San Joaquin Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 33%, Select Care Drugs: $3.00 $3,400
Sharp Direct Advantage Gold Card (HMO) – H5386-003-0 San Joaquin Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $2,900
Sharp SecureHorizons Plan by UnitedHealthcare (HMO) – H0543-145-0 San Joaquin Preferred Generic: $4.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,400
UC San Diego Health Humana (HMO) – H5619-131-0 Stanislaus Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,200
UnitedHealthcare Chronic Complete Focus (HMO C-SNP) – H0543-214-0 San Joaquin Preferred Generic: $4.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% N/A
Health Net Ruby Select (HMO) – H0562-124-0 Contra Costa Preferred Generic: $5.00, Generic: $8.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $6,700
Blue Shield AdvantageOptimum Plan (HMO) – H5928-050-0 San Benito Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 29% $3,400
Blue Shield Inspire (HMO) – H0504-047-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
AARP Medicare Advantage SecureHorizons (HMO) – H0543-022-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $4,900
Aetna Medicare Plus Plan (HMO) – H4982-012-0 San Joaquin Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $42.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $2,900
Anthem MediBlue Plus (HMO) – H0544-063-0 San Benito Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $6,700
Blue Shield 65 Plus (HMO) – H0504-029-0 Contra Costa Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $5,500
Central Health Ventura Medicare Plan (HMO) – H5649-008-0 Contra Costa Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $45.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $10.00 $5,000
Humana Gold Plus H5619-130 (HMO) – H5619-130-2 Contra Costa Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,900
Kaiser Permanente Senior Advantage Ventura (HMO) – H0524-034-0 Stanislaus Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Brand: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $5,000
My Choice (HMO) – H3815-029-0 Sonoma Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 33%, Select Care Drugs: $3.00 $2,900
WellCare Best (HMO) – H5087-024-0 San Joaquin Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $2,500
Anthem MediBlue Dual Advantage (HMO D-SNP) – H0544-055-0 Santa Clara Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25% N/A
Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) – H5619-038-0 San Joaquin Preferred Generic: $0.00, Generic: $19.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% N/A
Anthem MediBlue Dual Plus (HMO D-SNP) – H0544-090-0 San Joaquin Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25% N/A
Aetna Medicare Preferred Plan (HMO D-SNP) – H4982-009-0 Santa Clara, San Francisco Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% N/A
Central Health Ventura Medi-Medi Plan (HMO D-SNP) – H5649-009-0 Santa Clara Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25%, Select Care Drugs: $10.00 N/A
Connected Care (HMO) – H2241-007-2 San Joaquin Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $1,499
Connected Care Select (HMO C-SNP) – H2241-020-0 San Benito Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Humana Gold Plus H5619-119 (HMO) – H5619-119-0 San Benito Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,000
My Choice (HMO) – H3815-028-0 Contra Costa Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 33%, Select Care Drugs: $3.00 $1,400
Aetna Medicare Plus Plan (HMO) – H4982-005-0 Contra Costa Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $42.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $4,200
Anthem MediBlue Select (HMO) – H0544-098-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $7,550
Health Net Ruby Select (HMO) – H0562-113-0 San Benito Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $6,700
UnitedHealthcare Dual Complete (HMO D-SNP) – H1375-001-0 Sonoma Tier 1: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 N/A
Anthem MediBlue Dual Plus (HMO D-SNP) – H0544-087-0 San Benito Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25% N/A
Anthem MediBlue Plus (HMO) – H0544-056-0 San Joaquin Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $6,700
Blue Shield Inspire (HMO) – H0504-031-0 Contra Costa Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $5,500
Humana Gold Plus H5619-013 (HMO) – H5619-013-0 Contra Costa Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,900
Anthem MediBlue Dual Advantage (HMO D-SNP) – H0544-052-0 San Joaquin Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25% N/A
UnitedHealthcare Dual Complete (HMO D-SNP) – H1375-002-0 Kern Tier 1: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 N/A
Humana Gold Plus H5619-015 (HMO) – H5619-015-0 Contra Costa Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,900
Aetna Medicare Plus Plan (HMO) – H4982-010-0 San Joaquin Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $42.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $2,900
Blue Shield AdvantageOptimum Plan (HMO) – H5928-044-0 San Benito Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Health Net Healthy Heart (HMO) – H0562-090-0 San Joaquin Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $4,700
Health Net Jade (HMO C-SNP) – H0562-118-0 Sonoma Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $10.00, Non-Preferred Drug: $75.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Health Net Ruby Select (HMO) – H0562-112-0 Stanislaus Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $35.00, Non-Preferred Drug: $75.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $2,750
Humana Gold Plus H5619-012 (HMO) – H5619-012-0 Sonoma Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,100
Health Net Amber II Premier (HMO D-SNP) – H3561-001-0 San Joaquin Preferred Generic: $0.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 49%, Specialty Tier: 25% N/A
Blue Shield Inspire (HMO D-SNP) – H5928-054-0 Fresno, Stanislaus, San Joaquin Preferred Generic: $0.00, Generic: 25%, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25% N/A
AARP Medicare Advantage SecureHorizons Focus (HMO) – H0543-196-0 San Benito Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,400
AllCare Preferred Plan (HMO) – H3815-011-0 Contra Costa Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 33%, Select Care Drugs: $5.00 $2,900
Anthem MediBlue Care On Site (HMO I-SNP) – H0544-050-0 San Joaquin Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Diabetes Care (HMO C-SNP) – H0544-104-0 San Benito Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Heart Care (HMO C-SNP) – H0544-105-0 San Benito Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Lung Care (HMO C-SNP) – H0544-103-0 Contra Costa Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue StartSmart Plus (HMO) – H0544-121-2 Contra Costa Preferred Generic: $5.00, Generic: $12.50, Preferred Brand: $40.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $10.00 $3,400
Anthem MediBlue Value (HMO) – H0544-107-0 Contra Costa Preferred Generic: $0.00, Generic: $9.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,400
Balance (PPO) – H4961-006-0 Contra Costa Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 33%, Select Care Drugs: $3.00 $2,850
Blue Shield AdvantageOptimum Plan (HMO) – H5928-051-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Connected Care (HMO) – H2241-007-1 Sonoma Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $1,499
Connected Care Select (HMO C-SNP) – H2241-021-0 Stanislaus Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Health Net Ruby (HMO) – H0562-120-0 San Joaquin Preferred Generic: $5.00, Generic: $8.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,450
Humana Gold Plus H5619-032 (HMO) – H5619-032-0 Kern Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,450
My Choice (HMO) – H3815-006-0 San Joaquin Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 33%, Select Care Drugs: $5.00 $4,900
SCAN Balance (HMO C-SNP) – H5425-070-0 San Joaquin Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $30.00, Non-Preferred Drug: $85.00, Specialty Tier: 33% N/A
SCAN Classic (HMO) – H5425-069-0 Kern Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $40.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% $3,400
AARP Medicare Advantage SecureHorizons Focus (HMO) – H0543-193-0 San Benito Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% $4,000
Aetna Medicare Plus Plan (HMO) – H4982-006-0 San Joaquin Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $42.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $3,400
Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan) – H6229-006-0 San Benito Tier 1: 0%, Tier 2: 0%, Tier 3: 0%, Tier 4: 0% N/A
Anthem MediBlue Diabetes Care (HMO C-SNP) – H0544-102-0 Contra Costa Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Heart Care (HMO C-SNP) – H0544-106-0 Contra Costa Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Lung Care (HMO C-SNP) – H0544-101-0 Contra Costa Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Plus (HMO) – H0544-108-0 Contra Costa Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,450
AVA (HMO) – H3815-026-0 San Joaquin Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 33%, Select Care Drugs: $3.00 $1,999
Blue Shield Inspire (HMO) – H0504-046-0 Sonoma Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Choice (HMO) – H1426-002-0 Santa Clara Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $45.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,550
My Choice (HMO) – H3815-007-0 Santa Clara, San Francisco Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $40.00, Non-Preferred Drug: $100.00, Specialty Tier: 33%, Select Care Drugs: $5.00 $3,000
Santa Clara Family Health Plan (Medicare-Medicaid Plan) – H7890-001-0 Kern Tier 1: 0%, Tier 2: 0%, Tier 3: 0%, Tier 4: 0% N/A
SCAN Options (HMO) – H5425-073-0 Santa Clara Preferred Generic: $5.00, Generic: $12.50, Preferred Brand: $40.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% $3,400
Aetna Medicare Plus Plan (HMO) – H4982-007-0 Contra Costa Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $42.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $4,200
Anthem MediBlue Select (HMO) – H0544-069-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $7,550
Golden State Senior Health Plan (HMO) – H2241-014-0 San Joaquin Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,000
Health Net Ruby Select (HMO) – H0562-097-0 Sonoma Preferred Generic: $0.00, Generic: $3.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $4,400
Anthem MediBlue Dual Plus (HMO D-SNP) – H0544-089-0 Kern Preferred Generic: $0.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25% N/A
Anthem MediBlue Dual Advantage (HMO D-SNP) – H0544-054-0 San Joaquin Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 N/A
CCHP Senior Select Program (HMO D-SNP) – H0571-005-0 San Francisco Tier 1: 15% N/A
Imperial Dual Plan (HMO D-SNP) – H5496-011-0 San Francisco, Sacramento Preferred Generic: 0%, Generic: 25%, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25% N/A
Molina Medicare Complete Care (HMO D-SNP) – H5810-013-0 Sonoma Preferred Generic: $0.00, Generic: $14.00, Preferred Brand: $40.00, Non-Preferred Drug: 30%, Specialty Tier: 25% N/A
AARP Medicare Advantage Freedom Plus (HMO-POS) – H0543-215-0 San Benito Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,000
AARP Medicare Advantage SecureHorizons Focus (HMO) – H0543-169-0 Contra Costa Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,000
AARP Medicare Advantage SecureHorizons Plan 2 (HMO) – H0543-138-0 San Joaquin Preferred Generic: $0.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $1,900
Anthem MediBlue Select (HMO) – H0544-059-0 Sonoma Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $900
Astiva Health Advantage (HMO) – H1993-001-0 San Joaquin Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $32.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $1,899
Clever Care Longevity Medicare Advantage (HMO) – H7607-002-2 Orange Preferred Generic: 0%, Generic: $5.00, Preferred Brand: $35.00, Non-Preferred Brand: $75.00, Specialty Tier: 33%, Supplemental Drugs: $10.00 $2,999
OneCare Connect (Medicare-Medicaid Plan) – H8016-001-0 Orange Tier 1: 0%, Tier 2: 0%, Tier 3: 0% N/A
SCAN Classic (HMO) – H5425-007-0 Orange Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $37.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $799
SCAN Heart First (HMO C-SNP) – H5425-028-0 Orange Preferred Generic: $0.00, Generic: $2.00, Preferred Brand: $37.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% N/A
OneCare (HMO D-SNP) – H5433-001-0 Orange Generic: $0.00 N/A
AARP Medicare Advantage SecureHorizons (HMO) – H0543-019-0 San Joaquin Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $2,900
Aetna Medicare Plus Plan (HMO) – H4982-003-0 San Joaquin Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $37.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $2,100
Aetna Medicare Select Plan (HMO) – H0523-031-0 San Benito Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,200
Anthem MediBlue Dual Plus (HMO D-SNP) – H0544-088-0 San Benito Preferred Generic: $0.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25% N/A
Anthem MediBlue Plus (HMO) – H0544-062-0 Contra Costa Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $2,800
Blue Shield 65 Plus (HMO) – H0504-038-0 Contra Costa Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Health Net Ruby (HMO) – H0562-079-0 San Joaquin Preferred Generic: $0.00, Generic: $13.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $2,200
Humana Gold Plus H5619-116 (HMO) – H5619-116-0 Kern Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $2,800
Kaiser Permanente Senior Advantage Basic Kern (HMO) – H0524-036-0 Kern Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Brand: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $4,000
Anthem MediBlue Dual Advantage (HMO D-SNP) – H0544-053-0 Kern Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25% N/A
Anthem MediBlue Care To You (HMO I-SNP) – H0544-093-0 San Joaquin Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Diabetes Care Plus (HMO C-SNP) – H0544-094-0 Contra Costa Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 N/A
Anthem MediBlue Plus (HMO) – H0544-064-0 San Joaquin Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $7,550
Anthem MediBlue StartSmart Plus (HMO) – H0544-121-1 San Benito Preferred Generic: $5.00, Generic: $12.50, Preferred Brand: $40.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $10.00 $3,450
Anthem MediBlue Plus (HMO) – H0544-095-0 San Joaquin Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,450
Blue Shield AdvantageOptimum Plan (HMO) – H5928-052-0 San Joaquin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
Choice (HMO) – H1426-001-0 San Joaquin Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $45.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,550
Humana Community (HMO) – H7621-003-0 San Joaquin Preferred Generic: $2.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,450
WellCare Best (HMO) – H5087-026-0 San Joaquin Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $25.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $2,500
Anthem MediBlue Dual Advantage (HMO D-SNP) – H0544-100-0 San Joaquin Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 N/A

Standalone Medicare Part D Plans in California

There is a wide variety of Medicare Part D plans available in every state, and California is no exception. Keep in mind that plans vary by county, and don’t forget to check that your CA Medicare Advantage plan doesn’t already include Part D prescription drug coverage.

Standalone Medicare Part D Plans in California

Plan Details Tiers
AARP MedicareRx Preferred (PDP)
S5820 – 031 – 0
by UnitedHealthcare
Monthly Premium: $99.30
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $5.00
Tier 2: $10.00
Tier 3: $45.00
Tier 4: 40%
Tier 5: 33%
AARP MedicareRx Saver Plus (PDP)
S5921 – 376 – 0
by UnitedHealthcare
Monthly Premium: $29.20
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $5.00
Tier 3: $25.00
Tier 4: 40%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 413 – 0
by UnitedHealthcare
Monthly Premium: $41.60
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $6.00
Tier 3: $40.00
Tier 4: 40%
Tier 5: 25%
Anthem Blue Cross MediBlue Rx Enhanced (PDP)
S5596 – 076 – 0
by Anthem Blue Cross MediBlue Rx (PDP)
Monthly Premium: $26.10
Annual Deductible: $300
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 39%
Tier 5: 26%
Anthem Blue Cross MediBlue Rx Plus (PDP)
S5596 – 034 – 0
by Anthem Blue Cross MediBlue Rx (PDP)
Monthly Premium: $79.90
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 33%
Anthem Blue Cross MediBlue Rx Standard (PDP)
S5596 – 033 – 0
by Anthem Blue Cross MediBlue Rx (PDP)
Monthly Premium: $84.20
Annual Deductible: $390
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $32.00
Tier 4: 27%
Tier 5: 25%
Blue Shield Rx Enhanced (PDP)
S2468 – 004 – 0
by Blue Shield of California
Monthly Premium: $130.40
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $43.00
Tier 4: 33%
Tier 5: 33%
Blue Shield Rx Plus (PDP)
S2468 – 003 – 0
by Blue Shield of California
Monthly Premium: $59.00
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $6.00
Tier 3: $39.00
Tier 4: 41%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 158 – 0
by Cigna
Monthly Premium: $27.70
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $30.00
Tier 4: 50%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 311 – 0
by Cigna
Monthly Premium: $24.00
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 18%
Tier 4: 43%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 277 – 0
by Cigna
Monthly Premium: $30.30
Annual Deductible: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $4.00
Tier 2: $10.00
Tier 3: $42.00
Tier 4: 49%
Tier 5: 31%
Clear Spring Health Premier Rx (PDP)
S6946 – 056 – 0
by Clear Spring Health
Monthly Premium: $13.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $40.00
Tier 4: 45%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 027 – 0
by Clear Spring Health
Monthly Premium: $29.50
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $42.00
Tier 4: 35%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 137 – 0
by Elixir Insurance
Monthly Premium: $15.10
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $6.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 25%
Elixir RxSecure (PDP)
S7694 – 032 – 0
by Elixir Insurance
Monthly Premium: $30.80
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: 15%
Tier 4: 29%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 202 – 0
by Express Scripts Medicare
Monthly Premium: $84.90
Annual Deductible: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $42.00
Tier 4: 49%
Tier 5: 31%
Express Scripts Medicare – Saver (PDP)
S5660 – 248 – 0
by Express Scripts Medicare
Monthly Premium: $26.50
Annual Deductible: $285
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $35.00
Tier 4: 50%
Tier 5: 28%
Express Scripts Medicare – Value (PDP)
S5660 – 134 – 0
by Express Scripts Medicare
Monthly Premium: $61.00
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $30.00
Tier 4: 50%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 114 – 0
by Humana
Monthly Premium: $30.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $1.00
Tier 3: 20%
Tier 4: 32%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 178 – 0
by Humana
Monthly Premium: $72.50
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $45.00
Tier 4: 49%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 211 – 0
by Humana
Monthly Premium: $17.20
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: 17%
Tier 4: 35%
Tier 5: 25%
Mutual of Omaha Rx Plus (PDP)
S7126 – 031 – 0
by Mutual of Omaha Rx
Monthly Premium: $100.00
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 35%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 101 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.00
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 23%
Tier 4: 44%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 064 – 0
by Aetna Medicare
Monthly Premium: $29.50
Annual Deductible: $250
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $35.00
Tier 4: 39%
Tier 5: 28%
SilverScript Plus (PDP)
S5601 – 065 – 0
by Aetna Medicare
Monthly Premium: $81.60
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $47.00
Tier 4: 45%
Tier 5: 33%
SilverScript SmartRx (PDP)
S5601 – 207 – 0
by Aetna Medicare
Monthly Premium: $7.20
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $19.00
Tier 3: $46.00
Tier 4: 48%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 094 – 0
by WellCare
Monthly Premium: $30.10
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $30.00
Tier 4: 35%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 066 – 0
by WellCare
Monthly Premium: $37.10
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $36.00
Tier 4: 39%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 295 – 0
by WellCare
Monthly Premium: $28.30
Annual Deductible: $385
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $3.00
Tier 3: $47.00
Tier 4: 42%
Tier 5: 26%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 155 – 0
by WellCare
Monthly Premium: $81.00
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $47.00
Tier 4: 44%
Tier 5: 33%
WellCare Value Script (PDP)
S4802 – 163 – 0
by WellCare
Monthly Premium: $17.20
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $7.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 201 – 0
by WellCare
Monthly Premium: $15.20
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%

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