Program Services
The San Mateo County ACE Program gives you access to a range of health care benefits and services. Below is an overview of what you get, along with links to more details.
ACE covers many services, including:
- Doctor and hospital visits
- Prescription medicines
- Eye care
- Preventive care – including check-ups, screenings, tests, immunizations and other office visits with a primary care doctor
- Emergency care (covered only at San Mateo Medical Center)
Prescription medicines
ACE covers brand and generic medicines prescribed by your doctor that are in the ACE Formulary. It also covers non-formulary medicines that your doctor prescribes and gets prior authorization for from HPSM. Some over-the-counter medicines may be covered if you have a doctor's prescription.
Costs
Annual Participant Fee
To join ACE, participants must pay a $360 application fee. Most participants then pay an annual participant fee of $360 for 12 months of health coverage. Members can either pay it once a year in full or in monthly payments of $30.
Co-pays
Co-pays are your out-of-pocket expenses for certain benefits, usually at the time of an appointment. In general, doctor’s appointments cost $15 and prescriptions cost $7. Some services have much higher co-pays. The maximum amount of co-pays per benefit year is $640. After that, you don’t need to pay any more co-pays for the rest of the benefit year. Keep track of your co-pays so you will know when you have reached this limit.
Fee Waiver
The participant fee and co-pays can be waived if you don’t earn enough money. If you are receiving monthly invoices but you think you qualify for the Fee Waiver, you can contact the Health Coverage Unit at 650-616-2002 or info-hcu@smcgov.org.