CareAdvantage Dual Eligible Special Needs Plan (D-SNP) 2025
CareAdvantage
by Health Plan of San Mateo
CareAdvantage is a health insurance program that combines Medicare and Medi-Cal into one comprehensive, convenient plan. It also provides extra benefits and is available to eligible HPSM Medi-Cal members.
Who is eligible
You can join CareAdvantage if you:
- Live in San Mateo County
- Have Medicare Parts A & B and
- Have full-scope Medi-Cal through the Health Plan of San Mateo
What is covered
No copays, premiums or deductibles for
- Doctor and hospital visits
- Shots and lab tests
- Chiropractor and acupuncture visits
... and more!
Large provider network to choose from
- 5,700 doctors
- 150 dentists
- 20 hospitals
Care Management
You will be matched with a Care Manager who is your one point of contact for all your health care needs. Your Care Manager works with you to create a care plan that coordinates all aspects of your care. They also help you:
- Find doctors and specialists
- Make health care appointments
- Set up no-cost rides to health care visits
- Help you transition smoothly back home after a hospital stay
- Get follow-up care after doctor's visits, hospital stays and outpatient surgery
- Connect you with programs such as home health care, housing supports, meal programs and more
Prescription medicine coverage managed by CareAdvantage
- $0 premium
- Low or no copays*
- Generic medicines $0, $1.60 or $4.80
- Brand-name medicines $0, $4.90 or $12.15
- More than 500 over-the-counter (OTC) medications at no cost
- Other medicine not normally covered by Medicare Part D including finasteride 1 mg (generic Propecia) for hair loss and tadalafil 5 mg (generic for Cialis) for erectile dysfunction.
No cost transportation
to approved health care appointments and the pharmacy – learn more
Dental care managed by HPSM
giving you more dentists to choose from – learn more
Vision care
including a free annual exam and $100 towards glasses or contacts every year.
Outpatient behavioral health care
that includes referrals to therapists in HPSM’s network.
Ready to Join?
For information, call a licensed CareAdvantage Medicare Specialist
Toll free: 1-888-252-3153 Local: 650-616-1500
TTY: 1-800-735-2929 or dial 7-1-1
Hours: Monday–Friday 9:00 a.m. to 6:00 p.m.
CareAdvantage Dual Eligible Special Needs Plan (D-SNP) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Limitations and restrictions may apply. For more information, call the CareAdvantage Unit or read the CareAdvantage D-SNP 2025 Member Handbook.
Benefits and co-pays may change on January 1 of each year.
If you speak other languages other than English, language assistance services, free of charge, are available to you. Call 1-866-880-0606 (TTY: 1-800-735-2929 or dial 7-1-1). ( Download this statement in multiple languages.)
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Page updated November 1, 2024