A Medicare Advantage Plan in San Diego County, CA can provide additional benefits above and beyond Original Medicare. There are 58 Medicare Advantage Plans (Part-C) available in San Diego County from 16 different health insurance providers to compare in 2023. 40 of these Medicare Advantage Plans offer additional gap coverage to help avoid the “donut hole”. The plan with the lowest out-of-pocket expense is $650 and the highest out-of-pocket is $8300. San Diego County California qualifying beneficiaries can also pick from 26 Medicare Special Needs Plans. The highest rated Medicare Advantage Plan in San Diego County California received a 5 overall star rating from CMS.

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•HMO - Health Maintenance Organization. A Health Maintenance Organization manages your Part A and Part B health insurance benefits. In most cases you need to choose a primary care doctor. Health Maintenance Organization's offers services through a network of contracted hospitals, doctors and other providers, and the plan pays the providers directly. You generally must receive all Healthcare from the plan providers or through referrals from the plan provider. Emergency care, and out-of-area urgent care is still covered. An HMO-POS plan allows you to get some services out-of-network.

•PPO - Preferred Provider Organization. A Preferred Provider Organization offers a network of doctors, hospitals, and other providers you can choose from. Because providers are preferred, you can save money by using in network providers or usually pay a higher cost to use out-of-network providers. A primary care doctor is not required.

•PFFS - Private Fee For Service. A Private Fee For Service plan allows you greater flexibility in choosing a California provider. You may obtain covered services from any Medicare eligible provider who is willing to accept the plan's terms. The Healthcare provider must agree to accept the plan's terms before each visit. Some of these plans have a network of approved providers that have agreed to treat plan members.

•SNP - Special Needs Plan. A Special Needs Plan is for individuals who receive Medicare and Medicaid, have specific severe or disabling chronic conditions or reside in a licensed nursing home or skilled facility. SNP plans must provide prescription drug coverage to San Diego County California residents.

•Cost - Cost Plan. A cost plan doesn't replace your Original Medicare. It offers additional benefits to Original Medicare. If the cost plan doesn't include prescription drug coverage, you can enroll in a Part-D plan separately.

Yes. 40 Medicare Advantage Plans in San Diego County offer additional gap coverage. Once in the coverage gap, you’ll pay no more than 25% of the cost for brand-name and generic prescription drugs. If you choose a drug plan that includes coverage in the gap, you may get a discount applied to the drug's price.

There are 58 Medicare Advantage Plans available in San Diego County, California from 16 different health insurance providers. These plans offer additional benefits that aren't available through Original Medicare. Medicare beneficiaries who are interested in a Part-C policy may choose among many plans to compare versus San Francisco County Medicare Advantage Plans.

Individuals who are interested in a Medicare Advantage Plan in California may choose among many cost options depending on your necessary benefits. The lowest plan premium is $0 and the highest premium is $87. The deductibles in San Diego County range from $0-$505. The plan with the lowest out-of-pocket (MOOP) expense is $650 and the highest out-of-pocket is $8300.

• Are you eligible for a Medicare Advantage Plan?

• How much are the premiums, deductibles, and other costs?

• Is there a yearly limit on what you could pay out-of-pocket?

• Does the plan cover your prescription drugs?

• Will you hit the prescription drug coverage gap?

• Is your pharmacy in the plan’s network?

• Will your prescription drugs require prior authorization?

• How well does the plan cover the services you need like vision, hearing, or dental?

• Are your doctors in-network?

• Will you need to be referred to see a specialist?

• Does the plan cover services from out-of-network providers?

• How does the plan compare to your current coverage?

• Do you want to juggle multiple Medicare plans?

•C-SNP - Chronic Condition SNP. These plans help individuals receive customized care to fit their unique health care needs. You may qualify for C-SNP if you have one or more specific severe or disabling chronic conditions like:

• Stroke
• Certain neurologic disorders
• Certain chronic and disabling mental health conditions
• HIV/AIDS
• Certain chronic lung disorders
• Diabetes mellitus
• End-Stage Renal Disease (ESRD)
• End-stage liver disease
• Certain severe hematologic disorders
• Chronic alcohol and other drug dependence
• Certain cardiovascular disorders
• Cancer
• Chronic heart failure
• Certain autoimmune disorders
• Dementia

•I-SNP - Institutional SNP. These plans require 90 days or longer stay in a facility, or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), an intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility.

•D-SNP - Dual Eligible SNP. California Medicare and Medicaid enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid. Eligibility is based on a percentage of Federal Poverty Levels.

Below mentioned are the types of the enrollment period, along with the instructions on what to do during this period:

Initial Enrollment Period (IEP). This period starts 3 months prior to the month you will turn 65. It ends after 3 months you have turned 65. At this stage, you can sign up for a California Medicare Advantage Plan.

Annual Enrollment Period (AEP). Also known as the Open Enrollment Period, it starts on the 15th of October and ends on the 7th of December. At this stage, you can either sign up for the plan, switch or leave your current plan.

Special Enrollment Period (SEP). This enrollment period depends on the personal circumstances of the beneficiaries, like if you move or lose insurance coverage. Check to determine if you qualify to modify your plan.

Open Enrollment Period. Jan 1 – Mar 31. If you’re enrolled in a California Medicare Advantage Plan, you can switch to a different Medicare Part-C Plan in San Diego County, CA or switch to Original Medicare once during this time.

5-star Special Enrollment Period. Dec 8 - Nov 30. If a Centers for Medicare and Medicaid Services (CMS) 5-star plan is available in your area you can switch to the 5-star plan once during this period.

Centers for Medicare & Medicaid Service (CMS) assesses the quality of medical services of Medicare Advantage Plan using a 5-star rating system. A report is released yearly for the public to assess the quality of healthcare services. Thus, if you are searching for the highest Medicare Advantage Plan in your state, research the CMS ratings and costs of the plans report for further information.

Source: CMS. Data as of Oct 1, 2022.
Plans are subject to change as contracts are finalized.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2023, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.

Last updated on October 21, 2022