Santa Cruz County Medicare Advantage Plans

In this article...
  • Learn about premiums and deductibles for Medicare Advantage plans in Santa Cruz County. We look at the types of plans available and options for drug coverage.

Offered by private insurers, Medicare Advantage plans typically bundle your hospital and medical insurance together with benefits such as vision, dental and hearing. Plans that also include prescription drug coverage are known as Medicare Advantage Prescription Drug (MAPD) plans. Residents of Santa Cruz County can choose from 16 MAPD plans, which have about 5,640 beneficiaries. About 38% of the plans are rated four stars or higher by Medicare.

Average Cost of Medicare Advantage Plans in Santa Cruz County

When you're shopping for a Medicare Advantage plan in Santa Cruz County, you can expect to pay an average monthly premium of $27.81 in 2021. The annual drug deductible, which you must meet before prescription drugs are covered, averages $286.67 per year.

Each plan also caps the maximum spent on out-of-pocket costs within the plan's network. This cap averages $5,534 within Santa Cruz County. Once you've reached the plan's cap, the MAPD covers all additional costs.

Learn More About Medicare Advantage Prescription Drug Plans

There are four main types of Medicare Advantage plans to choose from:

  • Health Maintenance Organization (HMO): HMO plans usually have a network of health care providers that you must use to have services covered. In most cases, you must have a primary care doctor and a referral to visit a specialist.
  • Preferred Provider Organization (PPO): A PPO plan has a network of health care providers, but you can also use out-of-network providers if you're willing to pay a higher cost. You typically don't need a primary care doctor or a referral to see a specialist.
  • Private Fee-for-Service (PFFS): A PFFS plan sets the fee that it's willing to pay for services. You may use any health care provider that agrees to the plan's payment terms. A PFFS plan doesn't require you to choose a primary physician or have a referral for a specialist.
  • Special Needs Plan (SNP): SNP plans are tailored for beneficiaries with specific health needs, such as diabetes, dementia and heart disease.

If you prefer to remain in Original Medicare, you won't have prescription drug coverage unless you buy a standalone Part D prescription drug plan