2019 Alameda County Medicare Plans

Comprehensive benefits with extras you need and want

We’ve crafted two plans for Alameda County residents to choose from. Both plans offer prescription drug coverage and access to our Stanford Medicine, Sutter Health and affiliated network.

The chart below provides a brief summary of our benefits. See our Evidence of Coverage or Summary of Benefits documents for more information.

Benefit Highlights

Stanford Health Care
Advantage - Gold
Stanford Health Care
Advantage - Platinum

Monthly Premium

$69
$99

Out-of-pocket maximum
$5,900
$4,900

Outpatient Services

Primary Care Office Visit
$10
$10
Virtual Primary Care Visit
$10
$10
24 Hour Nursing Hotline
$0
$0
Specialist Office Visit
$30
$20
Lab Services
$10
$10
X-ray Services
$45
$25
Diagnostic Tests & Procedures
$45
$45
Comprehensive Dental
Not covered
Optional supplemental
benefis available for an
additional premium
Not covered
Optional supplemental
benefis available for an
additional premium
Vision
Not covered
Optional supplemental
benefis available for an
additional premium
Not covered
Optional supplemental
benefis available for an
additional premium
Eyeglass Frames and Lenses
(every 2 years)
Not covered
$25
(Up to a maximum benefit of $150)
Acupuncture
Not covered
$10
(15 visits per year)

Hospital and Emergency Care

Inpatient Hospital Care
$275 per day
(Days 1-7)

$0 copay the remainder
of your stay
$275 per day
(Days 1-7)

$0 copay the remainder
of your stay
Skilled Nursing Facility
$0
(Days 1-20)

$150
(Days 21-100)
$0
(Days 1-20)

$100
(Days 21-100)
Outpatient Surgery
20% Coinsurnace
$240
Emergency Care
$80
($0 if admitted within 24 hours)
$80
($0 if admitted within 24 hours)
Worldwide emergency
covered with
a $80 copay up to a
maximum of
$10,000 annually
Urgent Care
$35
($0 if admitted within 24 hours)
$35
($0 if admitted within 24 hours)
Worldwide urgent care
covered with
a $35 copay up to a
maximum of
$10,000 annually

Prescription Drug Coverage

These plans include Part D prescription drug coverage. The copayments below are for a one month supply of your prescription. Discounts are available for most prescriptions when when you use our mail order service for a three month supply. See our Comprehensive Formulary for a list of covered drugs.

Initial Coverage Stage?

Tier 1 Preferred Generics
$2
$2
Tier 2 Non-preferred Generics
$15
$15
Tier 3 Preferred Brand
$47
$47
Tier 4 Non-preferred Brand
$100
$100
Tier 5 Specialty
28% of Cost
33% of Cost
Tier 6 Select Care
$2
$2


Coverage Gap Stage

Tier 1 Preferred Generics
$5
$5
Tier 2 Non-preferred Generics
37% of cost
37% of cost
Tier 3 Preferred Brand
25% of cost
25% of cost
Tier 4 Non-preferred Brand
25% of cost
25% of cost
Tier 5 Specialty
25% of cost
25% of cost
Tier 6 Select Care
$2
$2


Catastrophic Coverage Stage

Generics
$3.40 or 5%
(Whichever is higher)
$3.40 or 5%
(Whichever is higher)
All Other Drugs
$8.50 or 5%
(Whichever is higher)
$8.50 or 5%
(Whichever is higher)

Optional Supplemental Benefits

In addition to the benefits that come with your plan, you can choose to add optional supplemental benefits. These optional supplemental benefits offer dental and vision coverage for an additional monthly premium that is added to your monthly plan premium.

Additional Monthly Premium
$20

Vision Services

WellVision Exam
$25 Copay every calendar year
Prescription Glasses
• Frame (included in prescription glasses)
$150 allowance for a wide selection of frames every other calendar year
• Lenses (included in prescription glasses)
Single vision, lined bifocal, and lined trifocal lenses every other calendar year
Contacts (instead of glasses)
$150 allowance for contacts every other calendar year
$60 maximum copay for contact lens exam (fitting and evaluation) every other calendar year

Comprehensive Dental

• Preventive Service - Initial/routine oral exams, teeth cleaning, fluoride treatment, sealant, x-rays as part of a general exam, nutritional counseling and oral hygiene instructions
$0 copay
• General Services - Fillings, general anesthetics, consultation, palliative treatment of dental pain
$0 - $125 copay
• Major Services - Initial/routine oral exams, teeth cleaning, fluoride treatment, sealant, x-rays as part of a general exam, nutritional counseling and oral hygiene instructions
$5 - $445 copay

FAQs

Find answers to the most common questions about Stanford Health Care Advantage.

Search

Find a doctor, look up services or your medication and search for a pharmacy.

Resources & Downloads

Need plan materials? Have common questions? View your answers and search for regulatory information and more.