Stanford Health Care Advantage Gold (HMO) Plan

No Deductibles

With Stanford Health Care Advantage, there are no additional premiums to pay for prescription drug coverage or extras like hearing benefits or transportation to appointments. There are also no annoying deductibles to meet. Your coverage begins right away.

Complete Coverage With One Plan From One Company

Unlike Original Medicare, Stanford Health Care Advantage bundles your medical, hospital, and prescription drug coverage together in one comprehensive plan. Additionally, our plans come with a number of valuable extra benefits that will save you time and money.

Valuable Extra Benefits

Every Stanford Health Care Advantage plan comes with important extra benefits for no additional premium including prescription drug coverage, hearing benefits, acupuncture and transportation to and from doctor appointments. Plus, members have the option to add dental and vision coverage.

Important Financial Protection

Stanford Health Care Advantage protects your savings and retirement by putting an annual limit on what you have to pay out of your own pocket for your covered medical expenses—important protection not offered by Original Medicare.


Benefits at a Glance:
We’ve Got You Covered From Head to Toe

The following table highlights just some of the many in-network benefits available to you as a valued Stanford Health Care Advantage member. For more details and a complete list of benefits, please review our Summary of Benefits or Evidence of Coverage which can be downloaded by clicking the links below.

Hospital & Medical Coverage

Your Stanford Health Care Advantage plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments for in-network providers.

Stanford Health Care Advantage Gold (HMO)
Monthly Premium $69
Maximum Out-of-Pocket Limit (What’s this?)This means you will never pay more than $6,500 per year for covered medical expenses, even if you have an unexpected illness or injury. If you reach this limit, you will no longer have to pay any copays or coinsurance. $6,500 Per Year
Annual Medical Deductible $0
Preventive Care/Screenings $0 Copay
Primary Care Doctor Visits $10 Copay
Specialist Doctor Visits $30 Copay
Urgent Care $35 Copay
Emergency Care $80 Copay
Lab Services $10 Copay
Home Health Care 100% Coverage
Chiropractic Care $20 Copay
Inpatient Hospital Care $275 Copay Per Day for Days 1-7,
$0 Per Day for Day 8 and beyond
Outpatient Surgery at Hospital 20% Coinsurance
Outpatient Surgery at Ambulatory Surgical Center 20% Coinsurance

Part D Drug Coverage

This table shows the drug tiers associated with your plan, and the copayments or coinsurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.

Stanford Health Care Advantage Gold (HMO)
Participating
Pharmacies
Annual Part D Deductible $250 Per Year
(applies to Tiers 3, 4, and 5)
Tier 1 – Preferred Generics $5 Copay
Tier 2 – Generics $15 Copay
Tier 3 – Preferred Brands $47 Copay
Tier 4 – Non-Preferred Brands $100 Copay
Tier 5 – Specialty Drugs 28% Coinsurance
Tier 6 – Select Care $2 Copay
Initial Coverage Limit $4,130 Per Year

Part D drug expenses are not covered under the maximum out-of-pocket limit. 


Extra Benefits

Your Stanford Health Care Advantage plan offers many valuable extras not offered by Original Medicare or Medicare supplement plans–at no additional cost to you.

Stanford Health Care Advantage Gold (HMO)
Hearing $0 Copay per Medicare-covered visit
Hearing aids and fitting not covered
Transportation Assistance $0 Copay for 24 one-way trips to approved locations per year
Silver&Fit® Not covered

Extra benefit expenses are not covered under the maximum out-of-pocket limit.


Important Plan Documents to Download

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