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Finest Medicare Benefit suppliers in San Francisco

An alternative way to get Original Medicare coverage, Medicare Advantage plans offer coverage that is equal to or greater than that of Medicare Parts A and B. In most cases, Medicare Advantage plans also provide additional coverage for prescription medications, vision care, and hearing health, among others. 

In San Francisco County, there are currently 11 companies that offer Medicare Advantage plans. While all of these plans will, at a minimum, provide coverage equal to that of Original Medicare, the best plans will also come with affordable premiums, minimal out-of-pocket costs, and high ratings from the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees all of these plans. 

Average Cost of Medicare Advantage Plans in San Francisco County

With Medicare Advantage plans, there are three primary costs to consider: monthly premiums, out-of-pocket limits, and––if a plan includes prescription drug coverage––Part D deductibles. 

In San Francisco County, the average monthly premium is $22.98 per month. The average out-of-pocket limit is $5,238 per year, and the average Part D deductible is $164.35 per year.

Keep in mind that Medicare Advantage beneficiaries still must pay their monthly Part B premium ($164.90 in 2023).

How We Chose the Best Providers

We chose our favorite Medicare providers above based on the following criteria:

  • Additional benefits: Every Medicare Advantage provider is legally required to, at a minimum, match the coverage of Original Medicare; however, most Medicare Advantage providers offer additional benefits on hearing health, dental, and in-home services. Since basic coverage will be the same, these additional benefits can make one provider a better fit over another.
  • Low costs: Most people pay nothing for a Medicare Part A premium. Because of this, we looked for Medicare Advantage plans with either a $0 or low monthly premium, as well as plans with a minimal out-of-pocket maximum. Keep in mind, however, that Medicare Advantage policyholders still need to pay Part B premiums.
  • Centers for Medicare and Medicaid Services (CMS) star ratings: Each year, CMS collects data on every Medicare Advantage plan — including surveys from members and healthcare providers — assigning a star rating from 1 to 5. Because Medicare Advantage plans vary by county, we looked at the star ratings for San Francisco county plans, which averaged 3.8 stars in 2022.

Our Recommended Medicare Advantage Providers in San Francisco

Anthem

Anthem BCBS is the largest Blue Cross and Blue Shield affiliate in the United States, and it currently offers four Medicare Advantage plans in San Francisco County, all of which have CMS ratings of 3.5 stars or higher. 

When it comes to Anthem Medicare Advantage, what we appreciate most are its allowances related to aging in place. On some plans, policyholders can receive $500 per year for assistive devices like medical alert systems. Additionally, some plans provide an allowance for home care services to help with daily activities. 

Additional Benefits

  • Vision: Routine vision services and up to $300 allowance for glasses or contact lenses annually
  • Dental: Up to $225 per quarter for comprehensive dental services
  • Hearing: Routine hearing tests and up to $3,000 annually for hearing aids
  • Transportation: Up to 48 one-way trips to healthcare visits
  • Fitness benefits through SilverSneakers
  • International coverage
  • Telehealth: Provided by Live Health Online
  • Over-the-counter allowance up to $125 each quarter
  • Emergency response device
  • In-home support
  • Home safety devices and modifications
  • Anthem offers plans in 14 states, which provides some flexibility if you choose to move

Plan Costs

Plan name Monthly premium Deductible Out-of-pocket maximum Prescription drug coverage
Anthem MediBlue Select (HMO) $0 $0 Medical
$0 Drug
$7,550 Yes
Anthem MediBlue Access (PPO) $30 $590 Medical
$370 Drug
$6,700 Yes
Anthem MediBlue Dual Plus (HMO D-SNP) $9.80 $0 Medical
$480 Drug
$7,550 Yes
Anthem MediBlue Dual Advantage (HMO D-SNP) $31.10 $0 Medical
$480 Drug
$7,550 Yes

Wellcare

Wellcare is now part of Centene, offering five Medicare Advantage plans in San Francisco, all of which are rated 4 stars by CMS. Wellcare is also one of the few carriers that allow you to spend your OTC benefit in retail locations, such as CVS, instead of solely mail orders. Beneficiaries with specific health conditions can also receive a $50 monthly allowance for approved groceries and $50 monthly for service animal support.

Additional Benefits

  • Vision: $400 for contacts, glasses, and frames annually
  • Dental: $1,000 for comprehensive dental, including dentures
  • Hearing: Up to $2,000 per year for hearing aids; one hearing aid per year
  • Transportation: 60 one-way trips per year
  • Fitness benefits: Administered by Peerfit Move
  • International coverage
  • Telehealth
  • Over-the-counter allowance of $155 quarterly
  • Emergency response device

Plan Costs

Plan name Monthly premium Deductible Out-of-pocket maximum Prescription drug coverage
Wellcare Specialty No Premium (HMO C-SNP) $0 $0 Medical
$0 Drug
$3,000 Yes
Wellcare No Premium (HMO) $0 $0 Medical
$0 Drug
$4,400 Yes
Wellcare Dual Liberty (HMO D-SNP) $0.00 $0 Medical
$480 Drug
$3,450 Yes
Wellcare Plus Sapphire II (HMO) $33.20 $0 Medical
$480 Drug
$3,450 Yes
Wellcare Premium Ultra (HMO) $121 $0 Medical
$0 Drug
$6,700 Yes

Kaiser Permanente

Kaiser Permanente is well known for its comprehensive model of care and excellent customer service. In San Francisco, many of its plans come with low premiums and extensive telehealth services that range from primary care checkups to counseling and occupational therapy. All of Kaiser’s Medicare Advantage plans also include Medicare Part D prescription drug coverage.

While the company offers only HMOs and Special Needs Plans (SNPs), its extensive network of hospitals and medical groups ensures that you’ll receive quality care within its network. CMS awards all of Kaiser’s San Francisco county’s Medicare Advantage plans the highest possible rating of 5 stars.

Additional Benefits

  • Vision: $40 allowance every two years toward contact lenses or glasses
  • Dental: Provided by DeltaDental of California
  • Hearing: Up to $360 per ear for one hearing aid every 36 months
  • Fitness benefits: Silver&Fit
  • International coverage
  • Telehealth services
  • Over-the-counter allowances for nicotine replacement

Plan Costs

Plan name Monthly premium Deductible Out-of-pocket maximum Prescription drug coverage
Kaiser Permanente Senior Advantage Basic SF (HMO) $19 $0 Medical
$0 Drug
$6,700 Yes
Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP) $31 $0 Medical
$480 Drug
$3,400 Yes
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) $79.00 $0 Medical
$0 Drug
$4,900 Yes
Kaiser Permanente Senior Advantage B Only North (HMO) $399.00 $0 Medical
$0 Drug
$6,700 Yes

UnitedHealthcare

AARP UnitedHealthcare is the largest provider of Medicare products in the United States, and its two Medicare Advantage plans available in San Francisco County come with monthly premiums under $40. Both of these plans have a 4-star rating from Medicare. 

In terms of benefits, UnitedHealthcare offers a generous quarterly allowance on over-the-counter products. Its Medicare Advantage plans also give policyholders a yearly hearing exam with a $0 copay, along with a potentially low copay on hearing aids. 

Additional Benefits

  • Vision: $100 every two years for frames or contact lenses through UnitedHealthcare Vision
  • Dental: Dental rider available for routine dental services
  • Hearing: $375-$1,425 copay for hearing aids
  • Transportation: 24 one-way trips to plan approved locations
  • Fitness benefits: Renew Active membership
  • International coverage
  • Telehealth
  • Over-the-counter allowance of up to $411 per quarter
  • Emergency response devices
  • United Healthcare offers plans in all 50 states

Plan Costs

Plan name Monthly premium Deductible Out-of-pocket maximum Prescription drug coverage
UnitedHealthcare Medicare Advantage Assure (HMO) $30 $0 Medical
$480 Drug
$7,550 Yes
UnitedHealthcare Canopy Health Medicare Advantage (HMO) $39 $0 Medical
$0 Drug
$3,500 Yes

Aetna

One of the most affordable Medicare Advantage providers, all four of this company’s plans come with a $0 monthly premium. In terms of CMS ratings, Aetna’s San Francisco County plans all scored respectably, between 3 to 4.5 stars.

Owned by CVS Health, Aetna Medicare Advantage plans provide additional benefits through in-store CVS locations. As well as receiving an allowance for over-the-counter items, Aetna policyholders can also visit CVS walk-in clinics for the same copay as a visit to their primary care physician.

Additional Benefits

  • Vision: $400 plan allowance annually
  • Dental: Provided by Liberty Dental network
  • Hearing: $2,500 per year per ear
  • Transportation: Up to 40 one-way trips per year to healthcare visits
  • Fitness benefits: Offered through SilverSneakers
  • International coverage
  • Telehealth
  • Over-the-counter allowance up to $150
  • Emergency response device
  • Aetna offers plans in 46 states and Washington, D.C.

Plan Costs

Plan name Monthly premium Deductible Out-of-pocket maximum Prescription drug coverage
Aetna Medicare Elite Plan (PPO) $0 $750 Medical
$0 Drug
$6,700 (in network)
$11,300 (out of network)
Yes
Aetna Medicare Plus Plan (HMO) $0 $0 Medical
$0 Drug
$3,400 Yes
Aetna Medicare Eagle Plan (HMO) $0 $0 Medical $4,200 No
Aetna Medicare Preferred Plan (HMO D-SNP) $0 $0 Medical
$425 Drug
$7,550 Yes

Alignment Health Plan

In 2013, Alignment Health Plan was formed on the premise of putting seniors first and serving the Medicare and Medicaid communities in California. In particular, we were impressed by its ACCESS On-Demand Concierge service, which gives policyholders 24/7 access to a doctor hotline as well as an Alignment Concierge team that can help subscribers better understand plan benefits and how to use them. 

Alignment Health Plan is also ranked highly by CMS, with its plans earning an average rating of 4.5 stars.

Additional Benefits

  • Vision: $500 every two years for eyewear
  • Dental: Up to $300 plan allowance per quarter
  • Hearing: $2,000 every two years for hearing aids.
  • Fitness benefits
  • International coverage
  • Transportation to and from in-network healthcare facilities
  • Telehealth
  • Over-the-counter allowances
  • Emergency response devices

Plan Costs

SCAN Health Plan

Rated 4.5 stars by CMS, SCAN Health Plan is one of the most comprehensive options for Medicare Advantage coverage in San Francisco. Its plans have low premiums, Part D drug coverage, and additional benefits for vision, dental, and hearing health. 

In particular, we appreciated its special-needs plans, which are designed for those with diabetes and chronic heart conditions. These plans provide specialized coverage for the medications and services needed to treat these conditions, and there is no charge for primary care office visits. 

Additional Benefits

  • Vision: Up to $300 annually for eyewear
  • Dental: Provided by DeltaCare USA
  • Hearing exams covered
  • Transportation: 48 one-way trips to healthcare visits
  • Fitness benefits: Provided by the SCAN Plus network
  • International coverage
  • Telehealth: Administered by Healthtech
  • Over-the-counter allowance up to $100 per quarter
  • In-home support
  • Home safety devices and modifications
  • Emergency response device

Plan Costs

What Is Medicare Advantage?

Medicare Advantage plans (also known as Medicare Part C) combine your benefits from Original Medicare (Parts A and B). These Medicare Advantage plans take over the administration of your Medicare benefits and, in many cases, include Part D – prescription drug coverage. 

While Medicare Advantage plans are offered by private companies, their coverage must be at least as good as the benefits provided by Original Medicare and have an out-of-pocket limit for medical expenses. Most Medicare Advantage plans include extra benefits on hearing, vision, and dental health that go far beyond the coverage of Original Medicare. 

Unlike Medicare, which can be used at any doctor or hospital that accepts Medicare (the vast majority do), most Medicare Advantage programs are network-based and may charge extra for out-of-network services. 

Often, the primary benefits of Medicare Advantage are in the additional services offered. Particularly for special-needs plans, a policyholder might be able to pay the same price as they would with Original Medicare and obtain coverage far exceeding that of Parts A and B.

Medicare Advantage vs. Original Medicare

You cannot use both a Medicare Advantage plan and Original Medicare. Once you enroll in a Medicare Advantage plan, it’ll take over your Original Medicare benefits and administration. From there, Medicare allocates a set amount of funds to the Medicare Advantage company to cover your healthcare costs, and the insurance company manages your healthcare needs. 

Types of Medicare Advantage Plans

There are four main types of Medicare Advantage plans, each of which comes with a different approach to networks, referrals, and pricing. 

Health Maintenance Organization (HMO)

The most common type of Medicare Advantage plan is the HMO. These plans are designed to maintain and promote preventive health, find, and treat health conditions early on. This helps lower healthcare costs since catching medical issues early often makes them more manageable. 

With an HMO plan, you’ll select a primary care doctor to manage your healthcare. All of your medical visits, services, and procedures will start there. To see a specialist, you’ll be required to obtain a referral or authorization from your primary care provider, and in-network providers must perform all services. The only exception would be emergency care or dialysis when out of the area.

Preferred Provider Organization (PPO)

PPO Medicare Advantage plans allow you the freedom to see both in-network and out-of-network providers without required referrals. Staying in-network will lower your costs, but it isn’t necessary for treatment. These plans offer more freedom and control over your healthcare.

It’s important to understand that while this plan allows you to see any doctor who accepts Medicare, that doesn’t mean it’s a simple copay for out-of-network services. In most cases, you’ll pay a higher copay, but some out-of-network providers will require you to pay in full for the visit then and there. In this case, you’d then submit the receipt to the insurance company to be reimbursed the amount it would typically cover. 

Private Fee-for-Service (PFFS)

PFFS plans are not common. However, they have some unique features. For example, this is the only Medicare Advantage plan that allows you to enroll in a separate stand-alone drug plan if that benefit isn’t included in your PFFS plan. 

PFFS plans come with or without a network. When using a PFFS plan, the provider must agree to the terms and conditions of the PFFS plan at each visit. Because of this, your doctor may accept the terms today and then decide tomorrow they no longer accept the plan. This style of Medicare Advantage plan is more prevalent in rural areas with fewer providers. 

Special-Needs Plans (SNPs)

Medicare Advantage SNPs are designed specifically for Medicare beneficiaries with specific health or financial situations. There are three types: 

  • Dual SNP (D-SNP): D-SNPs are for lower-income Medicare beneficiaries who also receive Medicaid. These plans offer robust benefits and low or no costs for most services. In addition, the plan extras are geared toward individuals with a lower income.
  • Chronic SNP (C-SNP): C-SNPs are specifically designed for beneficiaries with chronic health conditions like diabetes. These plans will typically have a lower cost for treatments and medications related to the qualifying condition. Sometimes, these plans will have a care plan to help manage the health condition.
  • Institutionalized SNP (I-SNP): I-SNPs are for Medicare beneficiaries living in an institutionalized setting. 

How to Enroll In Medicare Advantage

To enroll in a specific Medicare Advantage plan, you must be actively enrolled in Medicare Parts A and B and live in the plan’s service area. It’s wise to work with a licensed broker to help you check your doctors and prescriptions against the available plans to ensure you select the plan that meets your individual needs. If you don’t have a broker, you can find one using a free online directory. 

To sign up for a Medicare Advantage plan, you must be in a valid enrollment period. Medicare Advantage enrollment periods include:

  • Annual Enrollment Period: October 15 to December 7
  • Medicare Advantage Open Enrollment Period: January 1 to March 31
  • Initial Enrollment Period: Three months before and after your Medicare start date
  • Initial Coverage Enrollment Period: Three months before your Medicare start date if you delayed Medicare coverage
  • Special Enrollment Period (SEP): There are several specific conditions that trigger a SEP, including moving out of your plan’s coverage area or receiving new state or federal assistance for your Medicare costs

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