Sharp Direct Advantage VIP (HMO)

Sharp Direct Advantage VIP (HMO) is a HMO plan offered by Sharp Health Plan available for the 2026 plan year to people living in Sharp Direct Advantage VIP San Diego County. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that Sharp Direct Advantage VIP (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 VIP (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 Sharp Direct Advantage VIP (HMO) Medicare plan offers an Enhanced Alternative drug benefit with a $350.00 prescription drug deductible. After meeting this deductible, you will pay standard copayments or coinsurance during the initial coverage phase until total drug costs reach $2,100.00. Individuals who qualify for the low-income subsidy will see their Part D premium reduced to zero. Under this plan, Tier 1 preferred generics have an $8.00 copay at standard pharmacies and no copay through standard mail, while Tier 5 specialty drugs feature no copay. Standard generics and preferred brands carry copays of $40.00 and $90.00 respectively, whereas non-preferred drugs require a 29% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter catastrophic coverage and pay nothing for covered Part D drugs.

Additional Benefits

The Sharp Direct Advantage VIP (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copays for preventive services, primary care options with low copays up to $30, and no coinsurance for many services. Inpatient hospital stays require a $250 copay for the first seven days and no copay thereafter, while emergency visits carry a $150 copay that is waived upon hospital admission. Outpatient services and procedures generally range from no copay to a $120 copay, providing clear cost expectations for major medical needs. This plan also includes valuable supplemental benefits, such as dental care with copays up to $495, and vision services featuring no copays or deductibles alongside a $300 annual eyewear allowance. Additionally, members benefit from hearing coverage that includes routine exams and a $3,800 allowance for hearing aids every three years, as well as a $140 quarterly allowance with no copay for over-the-counter items. Specialized medical services like durable medical equipment and dialysis require a 20% coinsurance, while diagnostic radiological scans feature copays ranging from no copay to $75.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.