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Contra Costa Health Care Plus (HMO D-SNP) H5119-001 • 2027 • Contra Costa County, CA

CMS Rating: Not yet rated by CMS.
Monthly Premium
$7.30Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$9850.00In-network
Part B Giveback
Not offered
Prescription Coverage
Basic, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Contra Costa County, CA
Local Enrollment
578 beneficiaries in Contra Costa County
Last update:

Introduction

CMS Plan ID H5119-001 identifies Contra Costa Health Care Plus, a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Contra Costa Health Care Plus. Its provider network is a Health Maintenance Organization (HMO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $7.30 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.

Qualifying residents of Contra Costa County, California may enroll in this plan. CMS reports 578 beneficiaries enrolled in this plan in Contra Costa County. New members can call the plan directly at (844)729-8411 (TTY 711) for assistance.

Eligibility

Contra Costa Health Care Plus is a Medicare D-SNP plan for people who qualify for both Medicare and Medicaid.

Special Needs Plan Type
Dual-Eligible Special Needs Plan (D-SNP)
Medicare Requirement
Medicare Part A and Part B
Special Needs Requirement
Must qualify for Medicaid
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Compare Similar Plans in Contra Costa County

Compare this plan with the most-enrolled other HMO D-SNP plan available in Contra Costa County, California. Enrollment is based on CMS local enrollment data.

HMO D-SNP plan comparison for Contra Costa County, California
Plan Detail Contra Costa Health Care Plus Kaiser Permanente Dual Complete North P17
CMS Plan ID H5119-001-0 H8794-017-0
Local Enrollment 578 7,959
Monthly Premium $7.30 $0.00
Medical Deductible Coming soon Coming soon
Maximum Out-of-Pocket $9,850.00 $9,850.00
Part B Giveback Coming soon Coming soon
Primary Care Coming soon Coming soon
Specialist Coming soon Coming soon
Part D Deductible $700.00 $700.00
CMS Star Rating Not yet rated 4.5
Dental Coming soon Coming soon
Vision Coming soon Coming soon
Hearing Coming soon Coming soon

Plan Benefits

Contra Costa Health Care Plus 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 H5119-001.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5119-001-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $0 copay

Preventive and Wellness Services

Annual wellness exam
Not covered
Telehealth benefit
Not covered
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: $0 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
$0 copay
Worldwide emergency care
Coming soon
Urgent care
$0 copay
Inpatient hospital care
Tier 1
$0 per day for days 1-60
$0 per day for days 61-90
$0 per day for days 91-150
Skilled Nursing Facility
Tier 1
$0 per day for days 1-20
$0 per day for days 21-100
Ground ambulance
In-network: $0 copay

Mental Health Services

Outpatient individual therapy
In-network: $0 copay
Outpatient group therapy
In-network: $0 copay
Inpatient psychiatric hospital care
Tier 1
$0 per day for days 1-60
$0 per day for days 61-90
$0 per day for days 91-150

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $0 copay
Occupational therapy
In-network: $0 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Durable medical equipment
In-network: $0 copay
Prosthetics
In-network: $0 copay

Medicare Part B Drugs

Chemotherapy
In-network: $0 copay
Other Part B drugs (Medicare-covered)
In-network: $0 copay

Dental Services

Oral exam
Not covered
Dental x-rays
Not covered
Cleaning
Not covered
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
Not covered
Eyeglass lenses only
Not covered
Eyeglasses (frames & lenses)
In-network: $0 copay
Upgrades
In-network: $0 copay

Hearing Services

Hearing exam
Not covered
Fitting/evaluation
Not covered
Prescription hearing aids
Not covered
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 Contra Costa Health Care Plus as a Part B benefit.

Prescription Drug Coverage

Contra Costa Health Care Plus 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.

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.

Contra Costa Health Care Plus (H5119-001-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:$7.30
Supplemental Part D Premium:$0.00
Total Part D Premium:$7.30
Low-Income Premium Subsidy:$7.28
Low-Income Premium Subsidy Paid by CMS:$7.30
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Contra Costa Health Care Plus starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Contra Costa Health Care Plus may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Contra Costa Health Care Plus (H5119-001-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic25% coinsurance$0.00 copay
Generic25% coinsurance25% coinsurance
Preferred Brand25% coinsurance25% coinsurance
Non-Preferred Drug25% coinsurance25% coinsurance
Specialty Tier25% coinsurance25% coinsurance
Select Care Drugs15% coinsurance$0.00 copay
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H5119)

Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.

2027 Medicare Star Ratings for Contract H5119
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Plan too new to be measured
Managing Chronic (Long Term) Conditions Plan too new to be measured
Member Experience with Health Plan Plan too new to be measured
Complaints and Changes in Plans Performance Plan too new to be measured
Health Plan Customer Service Plan too new to be measured
Drug Plan Customer Service Plan too new to be measured
Complaints and Changes in the Drug Plan Plan too new to be measured
Member Experience with the Drug Plan Plan too new to be measured
Drug Safety and Accuracy of Drug Pricing Plan too new to be measured

Contact Information for Contra Costa Health Care Plus

Website
Contra Costa Health Care Plus Plan Page
Providers
Contra Costa Health Care Plus Providers Page
Formulary
Contra Costa Health Care Plus Formulary Page
Pharmacy
Contra Costa Health Care Plus Pharmacy Page
New Member Health Plan Help
(844)729-8411
New Member Health Plan TTY
711
New Member Part D Help
(844)729-8411
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
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Contra Costa Health Care Plus (official source) http://www.cchealth.org/careplus October 4, 2026
CMS.gov Dual Eligible Special Needs Plans (D-SNPs) April 28, 2026
Medicare.gov Understanding Medicare Advantage Plans April 28, 2026
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You April 28, 2026

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.