CalOptima Health OneCare Complete (HMO D-SNP)

CalOptima Health OneCare Complete (HMO D-SNP) is a HMO D-SNP plan offered by Orange County Health Authority available for enrollment in 2025 to people living in Orange County, California. This plan received an overall rating of 3 out of 5 stars in 2026.

It's important to know that CalOptima Health OneCare Complete (HMO D-SNP) 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 CalOptima Health OneCare Complete (HMO D-SNP).

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

CalOptima Health OneCare Complete (HMO D-SNP) offers an enhanced alternative drug benefit with an annual prescription drug deductible of $615.00. If you qualify for the low-income subsidy, your Part D premium is reduced to $12.00. During the initial coverage phase, you will pay a 25% coinsurance for tier 1 preferred generic drugs at standard pharmacies until total drug costs reach $2,100.00. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for Medicare Part D covered drugs. This means you pay nothing for covered prescriptions for the rest of the year, although you may still share costs for certain excluded drugs. This plan structure provides clear cost-sharing phases to help you manage your healthcare budget.

Additional Benefits

CalOptima Health OneCare Complete (HMO D-SNP) provides robust coverage where most medical services, including primary care, outpatient care, emergency services, and medical equipment, feature a 20% coinsurance and no copay. Inpatient hospital stays and skilled nursing facility care are also covered, subject to Medicare-defined copays and coinsurance. However, some services like cardiac rehabilitation are not covered under this plan. For additional benefits, members receive a $500 annual hearing aid allowance, a $500 biennial eyewear allowance, and a $167 quarterly over-the-counter item allowance with no copay or coinsurance. While routine eye exams and Medicare-covered dental care are covered with a 20% coinsurance and no copay, routine dental cleanings and routine hearing exams are excluded. Many specialized services under this plan will require prior authorization or a doctor referral.