Medicare Advantage Plans for Contra Costa County
Click here for the Medicare Advantage plans chart.
Medicare Advantage (MAPD) plans are private insurance plans approved and subsidized by Medicare. They offer equivalent benefits to Medicare and are an alternative way of receiving Medicare coverage. You must have both Parts A and B of Medicare to join a Medicare Advantage plan and pay the same premiums, and any applicable income related surcharges and late enrollment penalties as those on Original Medicare.
All but one of the Medicare Advantage plans in Contra Costa County are HMO’s. That means you must use the plan’s network providers and get referrals from your primary care physician for specialists. Generally any specialists must be part of the same physician’s group (IPA) as your primary care physician. Joining a Medicare Advantage plan means you may not use your Medicare card outside the plan. Starting in 2023 there is one PPO plan available. With a PPO plan you can see providers who are outside the network for an additional cost.
Unless you are in your initial Medicare enrollment period or a special enrollment period, you can only join or leave a plan at certain times. Open enrollment occurs each year between October 15th and December 7th. An exception to this rule is offered for a 5-Star Plan, and for those who qualify for a C-SNP or I-SNP (chronic or institutionalized) special needs plan.
Specialized Medicare Advantage Plans
The Medicare Advantage Plans shown on this page are considered “general” plans, appropriate for most people. However, there are specialized Medicare Advantage Plans available for those who meet specific criteria. The information for those plans are can be found on different pages.
Plans for people with Medicare and Full Scope Medi-Cal (full Duals)
Plans for people with chronic conditions or who are receiving institutional care
Premium Reduction Plans for those covered under non-Medicare insurance such as VA
You may have heard about “flex cards”. The only plan in Contra Costa County that offers a Flex Card is the Wellcare Assist plan. This plan is primarily for people who receive “extra help”. This article will tell you more about Flex Cards.
Switching to a 5-Star Plan
At any time during the year you have the right to enroll in a 5-star plan (a plan with a 5 star rating). This applies whether you have Original Medicare, with or without a Prescription Drug Plan, a Medicare Advantage Plan, or Contra Costa Health Plan. Two 5-Star Medicare Advantage plans are available in Contra Costa County. Both are offered by Kaiser. Note that the 5-Star option can be used only one time each year.
Considerations When Choosing a Plan
Choosing the best plan for you can be confusing. Click here for things to consider when choosing a Medicare Advantage Plan. You can also contact HICAP for help in choosing a plan.
2023 Medicare Advantage Plans
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