HEALTH PLAN OF SAN MATEO CareAdvantage (HMO D-SNP) H6019-001 • 2027 • San Mateo County, CA
- 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
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- San Mateo County, CA
- Local Enrollment
- 7,977 beneficiaries in San Mateo County
Introduction
CMS Plan ID H6019-001 identifies HEALTH PLAN OF SAN MATEO CareAdvantage, a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by HEALTH PLAN OF SAN MATEO. 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.
Enrollment in this plan requires you to live in San Mateo County, California. CMS reports 7,977 beneficiaries enrolled in this plan in San Mateo County. New members can call the plan directly at (888)252-3153 (TTY (800)735-2929) for assistance.
Eligibility
HEALTH PLAN OF SAN MATEO CareAdvantage is a Medicare D-SNP plan for dual-eligible beneficiaries (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 San Mateo County
Compare this plan with the most-enrolled other HMO D-SNP plan available in San Mateo County, California. Enrollment is based on CMS local enrollment data.
| Plan Detail | CareAdvantage | Kaiser Permanente Dual Complete North P22 |
|---|---|---|
| CMS Plan ID | H6019-001-0 |
H8794-022-0 |
| Local Enrollment | 7,977 | 502 |
| 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 | Not yet rated |
| Dental | Coming soon | Coming soon |
| Vision | Coming soon | Coming soon |
| Hearing | Coming soon | Coming soon |
Plan Benefits
HEALTH PLAN OF SAN MATEO CareAdvantage 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 H6019-001.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H6019-001-0 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 stay - 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 stay
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
- Not covered
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 HEALTH PLAN OF SAN MATEO CareAdvantage as a Part B benefit.
Prescription Drug Coverage
HEALTH PLAN OF SAN MATEO CareAdvantage 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.
| 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 HEALTH PLAN OF SAN MATEO starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, HEALTH PLAN OF SAN MATEO CareAdvantage may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Generic | 24% coinsurance | 24% coinsurance |
| Brand | 25% coinsurance | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H6019)
Medicare evaluates plan quality using a star rating system developed by the Centers for Medicare & Medicaid Services (CMS). Ratings are based on measures such as health outcomes, member experience, and customer service, and are reported on a 1 to 5 star scale, with higher ratings indicating stronger overall performance.
| 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 HEALTH PLAN OF SAN MATEO
- Website
- HEALTH PLAN OF SAN MATEO Plan Page
- Providers
- HEALTH PLAN OF SAN MATEO Providers Page
- Formulary
- HEALTH PLAN OF SAN MATEO Formulary Page
- Pharmacy
- HEALTH PLAN OF SAN MATEO Pharmacy Page
- New Member Health Plan Help
- (888)252-3153
- New Member Health Plan TTY
- (800)735-2929
- New Member Part D Help
- (888)252-3153
- New Member Part D TTY Users
- (800)735-2929
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 | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| HEALTH PLAN OF SAN MATEO (official source) | http://www.hpsm.org | October 4, 2026 |
| CMS.gov | Dual Eligible Special Needs Plans (D-SNPs) | April 28, 2026 |
| Medicare.gov | Compare types of 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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