A non-government entity
Sharp Direct Advantage Platinum Card (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sharp Direct Advantage Platinum Card (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sharp Direct Advantage Platinum Card (HMO) in 2025, please refer to our full plan details page.
Sharp Direct Advantage Platinum Card (HMO) is a HMO plan offered by Sharp Healthcare available for enrollment in 2025 to people living in Sharp Direct Advantage Platinum San Diego County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Sharp Direct Advantage Platinum Card (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 Sharp Direct Advantage Platinum Card (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.
For Sharp Direct Advantage Platinum Card (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Sharp Direct Advantage Platinum Card (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Sharp Direct Advantage Platinum Card (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you may pay a copay or coinsurance depending on the drug tier and pharmacy. For example, standard mail order for preferred generic drugs has no copay, while standard pharmacy for preferred brand drugs has a $90 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Sharp Direct Advantage Platinum Card (HMO) plan offers a range of benefits, including inpatient and outpatient hospital care, with varying copays. Emergency, primary care, and specialist services are covered, with copays ranging from $5 to $90. This plan also provides coverage for preventive, hearing, vision, and dental services, with copays for exams and other services. Additionally, it includes benefits for ambulance, home health, and skilled nursing facility care, as well as medical equipment and home infusion services, with coinsurance or copay requirements depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-8, and no copay for days 9-90. For Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient services are covered under the Sharp Direct Advantage Platinum Card (HMO), including outpatient hospital services with a copay of $20.00-$175.00, observation services with a $150.00 copay, ambulatory surgical center services with a $175.00 copay, outpatient substance abuse services with a $20.00 copay for both individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Sharp Direct Advantage Platinum Card (HMO) plan, with a $20 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Sharp Direct Advantage Platinum Card (HMO) plan. Ground and Air Ambulance Services have a $250 copay, and there is no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Sharp Direct Advantage Platinum Card (HMO). Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Sharp Direct Advantage Platinum Card (HMO) plan covers primary care physician services with a $5 copay, chiropractic services with a $10 copay, occupational therapy services with a $30 copay, and specialist services with a $20 copay. Mental health, psychiatric, and opioid treatment services have a $20 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a $5 copay. Podiatry services are not covered.
Preventive Services See details
The Sharp Direct Advantage Platinum Card (HMO) plan covers preventive services including Medicare-covered zero dollar services, health education, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following a welcome visit, fitness benefits, and remote access technologies. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $5 copay, routine hearing exams (2 per year) with a $5 copay, and fitting/evaluation for hearing aids (2 per year) with a $5 copay. Prescription Hearing Aids are covered, with a maximum benefit of $4800 every three years, and OTC hearing aids are covered with a maximum benefit of $4800 every three years. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Sharp Direct Advantage Platinum Card (HMO) plan covers vision services, including eye exams with a copay between $0 and $20. Eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered with no copay, and contact lenses are covered. Upgrades are not covered.
Dental Services See details
The Sharp Direct Advantage Platinum Card (HMO) plan covers Dental Services, including Medicare Dental Services with a $30 copay, and Other Dental Services, which cover Oral Exams with a $0-$5 copay, Dental X-Rays, Other Diagnostic Dental Services with a $0-$5 copay, Prophylaxis (Cleaning) with a $15 copay, and Other Preventive Dental Services with a $0-$150 copay. Fluoride Treatment and Orthodontics are not covered, and Dental X-rays and Prophylaxis (Cleaning) are limited. Orthodontic Services cover Restorative Services with a $20-$425 copay, Adjunctive General Services with a $0-$50 copay, Endodontics with a $0-$475 copay, Periodontics with a $0-$450 copay, Prosthodontics (removable) with a $20-$495 copay, Prosthodontics (fixed) with a $30-$425 copay, and Oral and Maxillofacial Surgery with a $0-$65 copay. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Sharp Direct Advantage Platinum Card (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the Sharp Direct Advantage Platinum Card (HMO), including Durable Medical Equipment (DME) with 15% coinsurance, Prosthetics/Medical Supplies with 15% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 15% coinsurance. Diabetic Supplies and Durable Medical Equipment for use outside the home are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, and therapeutic radiological services, are covered with a coinsurance of at most 15%, while lab services have no copay. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Sharp Direct Advantage Platinum Card (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Sharp Direct Advantage Platinum Card (HMO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Sharp Direct Advantage Platinum Card (HMO) plan, with a doctor's referral and prior authorization required. For days 1-20 and 42-100, there is no copay, while days 21-41 have a $125 copay.
Other Services See details
The Sharp Direct Advantage Platinum Card (HMO) plan covers acupuncture with a $10 copay per visit, up to 30 treatments per year, and covers over-the-counter items with a maximum benefit of $170 every three months. Other services such as meal benefits, and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved