SFHP Care Plus (HMO D-SNP)

SFHP Care Plus (HMO D-SNP) is a HMO D-SNP plan offered by SAN FRANCISCO HEALTH AUTHORITY available for enrollment in 2026 to people living in San Francisco County. The overall rating for this plan is not yet available for 2026.

It's important to know that SFHP Care Plus (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 SFHP Care Plus (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 SFHP Care Plus (HMO D-SNP) plan features an Enhanced Alternative drug benefit with a $615.00 annual prescription drug deductible. After meeting this deductible, you will pay a 25% coinsurance for Tier 1 preferred generic, Tier 2 standard generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs at standard pharmacies. For Tier 5 specialty drugs, there is no copay during this initial coverage phase. If you qualify for the low-income subsidy, your premium is reduced to $12.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you transition to the catastrophic coverage phase and pay nothing for covered Part D prescriptions.

Additional Benefits

SFHP Care Plus (HMO D-SNP) provides robust medical coverage where most core services, including outpatient care, doctor visits, emergency services, and medical equipment, require a 20% coinsurance and no copay. Preventive care and home health services are available with no copay and no coinsurance, while Medicare Part B insulin is subject to a $35 copay. Inpatient hospital stays and skilled nursing facility care are covered under Medicare-defined coinsurance and copays with no copay required for inpatient admissions. This plan also features key supplemental benefits, including a $150 quarterly over-the-counter allowance and up to 24 acupuncture treatments per year. For vision and hearing care, members receive a 20% coinsurance and no copay for routine exams, alongside generous annual allowances of up to $2,000 for prescription hearing aids and $300 for eyewear. Medicare-covered dental services are also included with a 20% coinsurance and no copay.