CareAdvantage Benefits
CareAdvantage gives you access to a full range of health care benefits and services. Below is an overview of what you get, along with links to more details.
Health Care Services
CareAdvantage covers many health care services, including;
- Appointments with HPSM network providers
- Preventive care (such as health exams, screenings and more)
- Vision care, including eyeglasses or contact lenses
- Skilled nursing facility care
- Hospital services
- Adult day care through Community Based Adult Services (CBAS)
- Urgent care
- Medical emergencies: call 9-1-1 or go to the nearest emergency room
- Rides to healthcare appointments if you don't have another way to get there
- Over-the-counter drugs and medical supplies
- Coverage anywhere in the world for emergency care and transportation services
Prescription Drugs
CareAdvantage covers medications prescribed by your doctor. In general, CareAdvantage only covers prescriptions that are filled at network pharmacies. HPSM contracts with major chain pharmacies which are located throughout the country.
Costs
You have no co-pays for:
- Doctor visits
- Preventive services
- Vision care
- Hospital care
- ER visits / Urgent care
- Mental health services
- Skilled nursing facility care
- Hospital services
- Physical & occupational therapy
- Long-term nursing home care
- Rides to healthcare appointments
Prescription drug co-pays:
- Depend on your income
- Increase every January 1st
- Current co-pays range from:
- $0, $1.55 or $4.50 for generic drugs
- $0, $4.60 or $11.20 for brand-name drugs
There is no co-payment for:
- Drugs you get at a nursing home facility or hospital
- Some prescribed over-the-counter drugs covered through your Medi-Cal coverage
Nurse Advice Line
This toll-free phone hotline is open 24 hours a day, 7 days a week. Just call 1-833-846-8773.
Registered nurses are on hand to answer questions about your symptoms. They can tell you how urgently you need to see a doctor and may give you advice for self-care at home.
Care Management program
Helps get your doctors and HPSM all working to give you the focus and support you need to stay healthy. Your personal Care Manager helps you set health goals and make a plan for achieving them.
For more information, visit our Care Management page or call 650-616-2060
Health Education Unit
Provides information on a range of topics such as:
- How to quit tobacco and other similar products
- Managing your diabetes, asthma, blood pressure and more
For more information, visit our Health Information pages or call 650-616-2165
Free rides to health care appointments, the pharmacy, and other health care services
For members who don’t have other means of transportation to health care services. To schedule a ride, call American Logistics Company (ALC) at 1-877-356-1080 at least two (2) business days before your appointment (ALC is open Monday through Friday). If you have an urgent appointment, call as soon as you can.
Free interpreter services
If your doctor does not speak your language, interpreter services are available by phone and video. Just ask your doctor to call an interpreter during your visit. In special cases, an interpreter can go to the visit with you.
Doctor’s visits by phone or video
Many providers can give you advice over the phone or see you by video. Telephone and video visits are fully covered. Call your primary care provider (PCP) to check if they provide telephone or video visits.
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 2024 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, 2023