Advantage D-SNP (HMO) (HMO D-SNP)

Advantage D-SNP (HMO) (HMO D-SNP) is a HMO D-SNP plan offered by SAN JOAQUIN COUNTY HEALTH COMMISSION available for enrollment in 2026 to people living in S Joaquin, Stanislaus, Alpine, El Dorado counties. The overall rating for this plan is not yet available for 2026.

It's important to know that Advantage D-SNP (HMO) (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 Advantage D-SNP (HMO) (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 Advantage D-SNP (HMO) (HMO D-SNP) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, members pay a 25% coinsurance for Tier 1 through Tier 4 drugs at standard pharmacies, while Tier 5 specialty drugs have no copay. These standard pharmacy costs apply after the deductible is met and continue until total drug expenditures reach $2,100.00. For individuals who qualify for the low-income subsidy or Extra Help, the Part D cost is reduced to $2.80. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Part D prescription drugs. This plan offers a structured cost-sharing design to help you manage your medication expenses.

Additional Benefits

The Advantage D-SNP (HMO) (HMO D-SNP) plan offers comprehensive medical coverage, with many key services requiring no copay and a standard 20% coinsurance. This cost-sharing structure applies to primary care, outpatient services, emergency care, dialysis, and durable medical equipment, though prior authorization is required for several of these benefits. Inpatient hospital stays and skilled nursing facility care are also covered but are subject to Medicare-defined copays and coinsurance. For supplemental care, the plan provides routine hearing and vision exams with no copay and a 20% coinsurance, featuring allowances of up to $1,500 annually for prescription hearing aids and $300 every two years for eyewear. Members also receive an over-the-counter benefit of $150 every three months for health-related items. However, standard dental services are limited to Medicare-covered dental benefits with a 20% coinsurance, and routine transportation is not covered.