Your Guide to Medicare Advantage in Santa Clara County, CA
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Welcome to our comprehensive guide to Medicare Advantage Plans in Santa Clara County, California for 2025. With 30 plans available, it’s important to find the one that best suits your healthcare needs. This guide will help you explore and compare your options, providing all the information you need to make an informed decision.
Medicare Advantage Plan Options for Santa Clara County
Explore the 30 Medicare Advantage Plans currently offered in Santa Clara County. Take a closer look at any plan, and you'll find a dedicated page packed with benefit and coverage details.
Santa Clara County, California Medicare Advantage Plans
| Plan Name | Type | Premium | MOOP | Rx Ded. | Rating |
|---|---|---|---|---|---|
| Aetna Medicare Core* | PPO | $0 | $5,900 | $590 | |
| Aetna Medicare Core II* | PPO | $46 | $4,900 | $590 | |
| Aetna Medicare Eagle Plus* | PPO | $0 | $6,750 | N/A | |
| Kaiser Permanente Sr Adv Basic Santa Clara* | HMO | $0 | $6,000 | $0 | |
| Kaiser Permanente Sr Adv Enhanced Santa Clara* | HMO | $65 | $3,900 | $0 | |
| SCAN Classic* | HMO | $0 | $1,200 | $0 | |
| SCAN MyChoice* | HMO | $0 | $1,200 | $0 | |
| Alignment Health Harmony | HMO | $0 | $3,400 | $0 | |
| Alignment Health Heroes+ | HMO | $0 | $5,900 | $590 | |
| Alignment Health My Choice CalPlus | HMO | $0 | $3,499 | $0 | |
| Alignment Health smartHMO | HMO | $0 | $3,999 | $590 | |
| Alignment Health Sutter Advantage | HMO | $49 | $4,900 | $0 | |
| Alignment Health the ONE + Rite Aid | HMO | $0 | $3,400 | $0 | |
| Astiva Health Premier Plan - NorCal | HMO | $0 | $1,500 | $0 | |
| Astiva Health Savings Plan - NorCal | HMO | $0 | $3,000 | $0 | |
| Blue Shield Inspire | HMO | $38 | $5,700 | $0 | |
| Imperial Courage Plan | HMO | $0 | $2,999 | N/A | |
| Imperial Dynamic Plan | HMO | $0 | $297 | $0 | |
| Imperial Giveback | HMO | $0 | $9,350 | $590 | |
| Imperial Traditional | HMO | $0 | $1,499 | $0 | |
| AARP Medicare Advantage from UHC CA-010P | HMO-POS | $0 | $2,500 | $340 | |
| Anthem Medicare Advantage | HMO-POS | $0 | $2,899 | $0 | |
| Anthem Prime | HMO-POS | $0 | $800 | $0 | |
| Wellcare Low Premium | HMO | $37 | $4,150 | $420 | |
| Aetna Medicare Plus II | HMO-POS | $46 | $3,900 | $590 | |
| Central Health Classic Care Plan II | HMO | $0 | $2,499 | $100 | |
| Central Health Premier Plan I | HMO | $0 | $2,999 | $100 | |
| Central Health Valor Care Plan | HMO | $0 | $4,999 | N/A | |
| Alignment Health Advantage PPO | PPO | $50 | $2,850 | $0 | |
| **Certain PFFS, MSA, and HMO-POS plans have a combined in and out-of-network maximum. Limits are detailed on the plan pages. | |||||
Overview of Medicare Advantage Plans
Medicare Advantage Plans, or Part C, are health plans provided by private insurers that offer all-in-one coverage, combining Medicare Part A (hospital coverage) and Part B (medical coverage). Many of the 30 plans available to you in Santa Clara County also include additional benefits like prescription drug coverage, as well as dental, vision, and wellness services, offering a more comprehensive package than Original Medicare.
- Health Maintenance Organization (HMO): Medicare Advantage HMO Plans require members to use a specific network of doctors and hospitals in Santa Clara County and usually requires referrals for specialist care. HMOs tend to be more affordable but come with restrictions on provider choice.
- Preferred Provider Organization (PPO): Allows more flexibility in choosing healthcare providers, with the option to see specialists without referrals, though often at a higher cost. Medicare Advantage PPOs usually have higher premiums and out-of-pocket expenses.
- Private Fee-for-Service (PFFS): Members can visit any Medicare-approved doctor or hospital in Santa Clara County that agrees to the plan's terms. Medicare Advantage PFFS plans offer more freedom in choosing providers but may have higher associated costs.
- Medicare Savings Account (MSA): This plan pairs a high-deductible Medicare Advantage plan with a savings account that the plan funds. You can use the money in the savings account to pay for healthcare expenses before meeting your deductible. Any unused funds roll over year to year, offering a way to manage healthcare costs with greater flexibility.
You may also have Medicare HMO-POS plans available. It's a type of HMO that offers a little more more flexibility. Like a regular HMO, you typically use the plan's network of doctors and hospitals for care, usually requiring a referral to see specialists. However, an HMO-POS plan lets you receive certain healthcare services outside of the network at a higher cost.
Benefits of Medicare Advantage Plans
Medicare Advantage Plans, also known as Part C, provide several key advantages over Original Medicare. Bundle up your healthcare with plans that cover Medicare Parts A and B, plus some extras like prescription meds, dental care, and vision services - it's a package deal! Medicare Advantage can be a smart choice if you want to maximize your healthcare dollars and enjoy extras like additional services and lower out-of-pocket costs.
Here are some of the top advantages these plans offer Santa Clara County residents:
- Cost Savings: Many plans have low or $0 premiums and offer capped out-of-pocket costs, providing financial protection against high medical expenses.
- Wellness Programs: Many plans offer gym memberships, wellness programs, and preventive care services to help maintain your health.
- Coordinated Care: Plans often include care coordination services, helping manage your healthcare across different providers and services.
- Comprehensive Coverage: Includes Medicare Part A, Part B, and often Part D (prescription drug coverage), along with additional benefits like dental, vision, and hearing.
How to Find the Best Medicare Advantage Plan for You
Selecting the ideal Medicare Advantage Plan from the 30 plans available in Santa Clara County involves evaluating several crucial aspects:
- Provider Network: Ensure your healthcare providers are within the plan's network to maintain continuity of care.
- Prescription Drug Coverage: Confirm that your current medications are included in the plan's formulary to avoid higher out-of-pocket costs.
- Costs: Assess the plan’s premium, deductible, and out-of-pocket expenses. The ideal plan aligns with both your financial situation and your healthcare needs.
- Additional Benefits: Identify any additional benefits that are important to you, such as fitness programs, routine dental, or over-the-counter medication benefits, and ensure the plan includes them.
- Plan Ratings: If a plan offers the benefits you need at a price you can afford, be sure to check its CMS star ratings. This will help you avoid plans with known problems, like poor customer service.
Discover the key factors to consider when comparing Medicare Advantage Plans.
Enrolling in Medicare Advantage Plans
Enrolling in a Medicare Advantage Plan is a straightforward process, but timing is crucial to ensure you don't miss out on the benefits. Understanding when you can enroll will help you take full advantage of the options available in Santa Clara County.
- Initial Enrollment Period (IEP): The IEP is a seven-month window surrounding your 65th birthday, allowing you to sign up for a Medicare Advantage Plan as soon as you become eligible for Medicare.
- Annual Enrollment Period (AEP): The AEP runs from October 15 to December 7 each year, giving you the opportunity to change, drop, or enroll in a Medicare Advantage Plan.
- Open Enrollment Period (OEP): Between January 1 and March 31, if you’re already enrolled in a Medicare Advantage Plan, you can switch plans or revert to Original Medicare.
To learn more about the enrollment periods and steps to take, check out our comprehensive Medicare Enrollment guide.
Plan Availability
The MA and MAPD plans on this page are available to people on Medicare enrolled in both Medicare Part A and Part B living in and all other areas of Santa Clara County, California.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Citations & References
- CMS.gov, "2024 Medicare Part C Landscape Source Files", Last Accessed October 14, 2023
- CMS.gov, "2024 Part C and D Performance Data", Last Accessed October 14, 2023
- Medicare.gov, "Types of Medicare Advantage Plans", Last Accessed 17 May, 2023
- Medicare.gov, "Special Needs Plans (SNP)", Last Accessed 11 June, 2024
- Medicare.gov, "Learn How Medigap Works", Last Accessed 1 July, 2024