TotalCare (HMO D-SNP)

TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by SANTA CRUZ MONTEREY MERCED SAN BENITO MARIPOSA MAN available for enrollment in 2026 to people living in Central California. The overall rating for this plan is not yet available for 2026.

It's important to know that TotalCare (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 TotalCare (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

The TotalCare (HMO D-SNP) Medicare plan provides an Enhanced Alternative drug benefit with a $615.00 prescription drug deductible. If you qualify for the low-income subsidy (LIS or Extra Help), your cost is reduced to $5.50. During the initial coverage phase, you will pay a 25% coinsurance for preferred generic, standard generic, and non-preferred drugs, and a 30% coinsurance for preferred brand drugs at standard pharmacies. There is no copay for Tier 5 specialty drugs under this plan during the initial coverage phase. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for your covered Medicare Part D prescription drugs.

Additional Benefits

The TotalCare (HMO D-SNP) plan offers comprehensive coverage for core medical services, with most outpatient, emergency, primary care, and diagnostic services requiring no copay and a standard 20% coinsurance. Inpatient hospital stays and skilled nursing facility care are partially covered following Medicare-defined copays and coinsurance, while home health services are available with no copay or coinsurance. Additionally, medical equipment, dialysis, and partial hospitalization are covered under the same 20% coinsurance and no copay structure. For specialty care, the plan provides Medicare-covered dental and vision benefits with no copay and a 20% coinsurance, including a $350 eyewear allowance every two years, though routine dental and hearing aids are not covered. Members also benefit from a $100 over-the-counter allowance every three months to help cover health-related items. However, certain services like routine transportation, cardiac rehabilitation, and annual physical exams are excluded from this plan.