Astiva Health Premier Plan - NorCal (HMO)

Astiva Health Premier Plan - NorCal (HMO) is a HMO plan offered by Astiva Health Holdings Incorporated available for enrollment in 2025 to people living in Counties: SCL. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that Astiva Health Premier Plan - NorCal (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Astiva Health Premier Plan - NorCal (HMO).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The Astiva Health Premier Plan - NorCal (HMO) offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will pay no copay for Tier 1 preferred generic drugs or Tier 5 specialty tier drugs at standard pharmacies. Standard pharmacy costs for other tiers include a $35 copay for Tier 2 standard generics, a $95 copay for Tier 3 preferred brands, and a 33% coinsurance for Tier 4 non-preferred drugs. For standard mail order, Tier 1 drugs require a $5 copay, Tier 2 drugs require a $35 copay, and Tier 5 specialty drugs have no copay. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Individuals who qualify for the low-income subsidy can also benefit from reduced premiums and costs.

Additional Benefits

The Astiva Health Premier Plan - NorCal (HMO) offers comprehensive medical coverage with predictable cost-sharing, including inpatient hospital stays and skilled nursing facility care for up to 100 days with no copay or coinsurance. Outpatient services feature low out-of-pocket costs, such as a $75 copay for ambulatory surgical center visits, no copay for urgent care, and an $85 copay for emergency services. Additionally, ground ambulance rides require a $150 copay, while up to 24 one-way health-related transportation trips are covered annually. For supplemental care, this plan provides valuable dental, vision, and hearing benefits with no deductibles. Members receive up to $875 in dental coverage every three months, a $300 eyewear allowance every two years, and up to $500 annually for prescription hearing aids alongside routine exams at no copay. Furthermore, Medicare-covered preventive services and durable medical equipment are available with no copays, though some medical supplies and dialysis require a 20% coinsurance.