If you feel that you qualify for this savings program, but the Medicare system does not have current or accurate information
about your income and resources, you can present your claim to be eligible.
Learn more about the Best Available Evidence policy
from the Centers for Medicare & Medicaid Services.
CareAdvantage (HMO SNP) is a health plan for residents of San Mateo County with full-scope Medi-Cal and Medicare Parts A and B.
CareAdvantage combines Medicare and Medical benefits into one simple plan.
Plan Restrictions
You can join CareAdvantage if you are entitled to full-scope Medi-Cal, Medicare Part A and enrolled in Medicare Part B
and live in the service area. Individuals with End Stage Renal Disease (kidney disease) generally are not eligible to enroll
in CareAdvantage unless they are members of our organization and have been since their dialysis began.
Premiums or Deductibles
CareAdvantage has no premiums or deductible for: health, dental, vision, and prescription drug coverage.
CareAdvantage has $0 Co-payments for:
- Medical services
- Hospital services
Co-pays for Prescription Drugs
The amount of your co-pay* will depend on the drug you are getting (generic or brand), your income, and how much you and HPSM
have already paid in the current year for your prescriptions. CareAdvantage members do not pay monthly premiums.**
- Generic drug co-pays will be $0, $1.10, or $2.60
- Brand drug co-pays will be $3.30, $6.50 or in some cases $0
There is No Co-payment for:
- Drugs you receive at a nursing home facility or at a hospital
- Some prescribed over-the-counter drugs that are covered only under the Medi-Cal part of your coverage
For additional information, see Deductibles, above.
* Co-payments may change on January 1, 2013.
** The Medicare Part B premium for dual eligible CareAdvantage members is covered by the Medi-Cal program.
*** $3.30 or $6.50 depending on your income.
CareAdvantage members also receive free taxi rides* to approved medical appointments, vision care,Ω and comprehensive dental coverage.¥
The Health Plan of San Mateo, which administers CareAdvantage, is a Medicare Advantage organization with a Medicare contract.
The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional
information about benefits is available to assist you in making a decision about your coverage. For more information, contact the plan.
You can also see the CareAdvantage Evidence of Coverage.
* CareAdvantage covers 50 free taxi rides (25 round-trip) to approved medical, dental, and vision appointments.
Ω CareAdvantage covers eye exams, and glasses or contacts once every two years, with a $125 cap on frames.
¥ CareAdvantage covers two free cleanings and one set of X-rays annually. $5–$20 co-pays for other services.