We have two plans – Stanford Health Care Advantage Gold and Stanford Health Care Advantage Platinum. Our plans include:
An integrated and coordinated health care experience from Stanford Health Care
A robust formulary with gap coverage
Benefits such as, fitness program and worldwide travel benefits (available in the Platinum plan only).
Optional supplemental benefits such as dental (DMO) and vision are available to both Platinum and Gold members for an additional premium
We want to help you get the most out of your Medicare coverage. That’s why we offer convenient extras that help you stay healthy and connected:
Health risk appraisals
Exclusive member events
Member Care Specialists, experienced in Medicare
Online access to a primary care doctor*—appointments via webcam for common, acute problems that do not require emergency or ongoing care
MyHealth—Stanford Health Care’s secure online service to view medical records, test results, prescriptions, and communications from your Stanford Medicine team*
Chronic disease management programs
Nurse advice line
Stanford Health Library information and programs
Yes, there is a prescription drug benefit under both plans. You need to use a contracted pharmacy to receive the plan benefit. In most cases, we will not pay for your prescription drugs if you use an out-of-network pharmacy.
To review a complete pharmacy directory, click here.
To learn more about the drugs we cover, click here.
You may be able to receive extra help to pay for your prescription drugs. To see if you qualify, call 1-800-Medicare (1-800-663-4327) or visit www.medicare.gov.
Stanford Health Care Advantage is currently available to Medicare beneficiaries residing in Alameda, San Mateo and Santa Clara Counties. Our plans feature a network of more than 200 primary care physicians and 2,200 specialists. And with clinics throughout, you can be sure to find us nearby.
To find out if your primary care physician or specialist is a part of Stanford Health Care Advantage, you can use our online Provider Search Tool.
Stanford Health Care will partner with you to manage any chronic conditions. We offer a variety of disease management and care coordination programs to advocate for you, aid in treatment, and keep all of your doctors and pharmacists in tune with each other.
We help by providing access to highly qualified doctors and specialists at Stanford Medicine and its affiliated provider network. Case managers work with individual members, their families, their providers and their pharmacists to plan and implement care for complex or chronic illnesses.
The answer in most instances is no. If you do need to complete any paperwork, our Member Care Specialists can help with the process, and find answers to any claims and billing questions.
Once we receive your completed enrollment form, we send it to CMS (the federal agency that administers Medicare) to confirm your eligibility to enroll in our plan. Once CMS confirms your enrollment, your Stanford Health Care Advantage member card will arrive.
If you are enrolled in the plan and need care or a prescription before your member card arrives in the mail, you can use your enrollment form and enrollment confirmation to receive covered services.
You may switch your doctor to any other Stanford Health Care Advantage primary care physician who is accepting new patients. You can view a listing of our primary care and specialty physicians here.
In any instance of a life-threatening emergency, always seek immediate medical attention. If your medical situation is not a life-threatening emergency, then you are strongly advised to see only doctors within the network.
Stanford Health Care Advantage requires that you have a referral (typically from your primary care physician – PCP) before going to see a specialist. Your PCP will refer you to a doctor in the Stanford Health Care Advantage network. Referrals to out-of-network doctors or providers need to be pre-approved by Stanford Health Care Advantage based on clinical necessity and circumstances.
If you do receive non-emergent care from an out-of-network provider that was not pre-approved by Stanford Health Care Advantage, normally you will have to pay for these services out of pocket and without help from Stanford Health Care Advantage. For questions about seeing an out-of-network provider, including when you travel, please contact Stanford Health Care Advantage Member Care Services.
To file a complaint with Stanford Health Care Advantage you will find instructions along with a form under the Member Forms header in the Resources & Downloads page of this website. Alternatively, you can visit www.medicare.gov and file a complaint directly with CMS.