Blue Shield Advantage (HMO) Medicare Advantage Plan H0504-053 • 2027 • Sacramento County, CA
- Monthly Premium
- $19.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3900.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $475.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Sacramento County, CA
- Local Enrollment
- 0 beneficiaries in Sacramento County
Blue Shield Advantage (HMO) Introduction
CMS Plan ID H0504-053 identifies Blue Shield Advantage, a Medicare Advantage HMO plan offered by Blue Shield of California. The plan uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $19.00 monthly premium, $0.00 medical deductible, and $3900.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $475.00.
Eligible Medicare beneficiaries residing in Sacramento County, California can enroll in this plan. CMS reports local enrollment of 0 beneficiaries for this plan in Sacramento County. New members can contact the plan at (888)534-4263 (TTY 711) for help and additional plan information.
Compare Similar Plans in Sacramento County
Compare this plan with the two most-enrolled HMO plans available in Sacramento County, California. Enrollment is based on CMS local enrollment data.
| Plan Detail | Blue Shield Advantage | Kaiser Permanente Sr Advantage Basic Sac., Sonoma | Kaiser Permanente Sr Adv Enhanced Sac., Sonoma |
|---|---|---|---|
| CMS Plan ID | H0504-053-0 |
H0524-051-0 |
H0524-013-0 |
| Local Enrollment | 0 | 29,576 | 19,490 |
| Monthly Premium | $19.00 | $29.00 | $99.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $3,900.00 | $6,000.00 | $3,900.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $0 copay | $30 copay | $15 copay |
| Part D Deductible | $475.00 | $0.00 | $0.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | Not covered | Not covered |
Plan Benefits
Blue Shield Advantage has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H0504-053.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H0504-053-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $0 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $100 copay
- Lab services
- In-network: $0 copay
- Outpatient x-rays
- In-network: $0 copay
- Diagnostic tests and procedures
- In-network: $0 copay
Emergency and Urgent Care Services
- Emergency room care
- $150 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0 copay
- Inpatient hospital care
- Tier 1
$200 per day for days 1-5
$0 per day for days 6-90
$0 per stay - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$200 per day for days 21-100 - Ground ambulance
- In-network: $285 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $30 copay
- Outpatient group therapy
- In-network: $30 copay
- Inpatient psychiatric hospital care
- Tier 1
$200 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $15 copay
- Occupational therapy
- In-network: $15 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $449-$999 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Blue Shield Advantage as a Part B benefit.
Prescription Drug Coverage
Blue Shield Advantage includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $475.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Blue Shield of California starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Blue Shield Advantage may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $5.00 copay | Coming soon |
| Preferred Brand | 21% coinsurance | Coming soon |
| Non-Preferred Drug | 26% coinsurance | Coming soon |
| Specialty Tier | 28% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H0504)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Blue Shield of California
- Website
- Blue Shield of California Plan Page
- Providers
- Blue Shield of California Providers Page
- Formulary
- Blue Shield of California Formulary Page
- Pharmacy
- Blue Shield of California Pharmacy Page
- New Member Health Plan Help
- (888)534-4263
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (888)534-4263
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Blue Shield of California (official source) | http://blueshieldca.com/medicare | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.