Gold Coast Health Plan Total Care Advantage (HMO D-SNP)

Gold Coast Health Plan Total Care Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Ventura County Medi-Cal Managed Care Commission available for enrollment in 2026 to people living in Ventura County. The overall rating for this plan is not yet available for 2026.

It's important to know that Gold Coast Health Plan Total Care Advantage (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 Gold Coast Health Plan Total Care Advantage (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 Gold Coast Health Plan Total Care Advantage (HMO D-SNP) features a defined standard prescription drug deductible of $615.00. After meeting this deductible, you enter the initial coverage phase where you pay for your covered medications until your total drug costs reach $2,100.00. If you qualify for the low-income subsidy, also known as LIS or Extra Help, your Part D premium is reduced to $12.00. Once 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. While you pay nothing for standard Part D prescriptions in this phase, you may still pay a share of the costs for any excluded drugs. This plan provides clear cost limits to help you manage your healthcare budget effectively.

Additional Benefits

Gold Coast Health Plan Total Care Advantage (HMO D-SNP) offers robust coverage for outpatient, emergency, primary, and specialist care with no copay and a 20% coinsurance. Inpatient hospital and skilled nursing facility services are also covered, with cost-sharing based on standard Medicare-defined rates. Many of these services, including diagnostic tests, medical equipment, and home health care, require a doctor referral or prior authorization. The plan also partially covers dental, vision, and hearing services with no copay and a 20% coinsurance, including up to two prescription hearing aids and a $350 annual limit for eyewear. While zero-dollar preventive services feature no copay or coinsurance, other benefits like cardiac rehabilitation, routine transportation, and over-the-counter items are not covered. Additionally, Medicare Part B insulin drugs require a $35 copay with up to a 20% coinsurance.