2018 Santa Clara County Medicare Plans

Comprehensive benefits with extras you need and want

We’ve created two carefully crafted plans for Santa Clara County residents to choose from. Both plans offer prescription drug coverage and access to our connected team of Stanford Medicine doctors 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

Enroll Now

Stanford Health Care
Advantage - Gold
Santa Clara County
Stanford Health Care
Advantage - Platinum
Santa Clara County

Monthly Premium

$55
$104

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-rays & Diagnostic Tests & Procedures
$45
$25
Comprehensive Dental
(every 6 months)
Not covered
Dental PPO
10% of Cost - in -
network cleaning
10% of Cost - in
network x-rays
10% of Cost - in -
network exam
Eye Exams for Glasses
(every year)
Not covered
$25
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 per day
(Days 21-100)
$0
(Days 1-20)

$100 per day
(Days 21-100)
Outpatient Surgery
20% coinsurance
$240
Emergency Care
$80
($0 if admitted within 24 hours)
$80
($0 if admitted within 24 hours)
Worldwide Urgent or Emergency Care
Not covered
$80
Up to a maximum of $10,000 annually
Urgent Care
$35
($0 if admitted within 24 hours)
$35
($0 if admitted within 24 hours)

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.


Plans
Stanford Health Care
Advantage - Gold
Santa Clara County
Stanford Health Care
Advantage - Platinum
Santa Clara County
Rx Deductible
$250 for Tiers 3,4, and 5
No Deductible

Initial Coverage Stage?

Tier 1 Preferred Generics
$5
$5
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
44% of cost
44% of cost
Tier 3 Preferred Brand
35% of cost
35% of cost
Tier 4 Non-preferred Brand
35% of cost
35% of cost
Tier 5 Specialty
35% of cost
35% of cost
Tier 6 Select Care
$2
$2


Catastrophic Coverage Stage

Generics
$3.35 or 5%
(Whichever is higher)
$3.35 or 5%
(Whichever is higher)
All Other Drugs
$8.35 or 5%
(Whichever is higher)
$8.35 or 5%
(Whichever is higher)

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.