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Senior Select Program (HMO D-SNP)

$0/month*

This plan is for price-sensitive individuals with Medicare Parts A & B who also receive Medi-Cal (Medicaid) benefits. Available exclusively in San Francisco County residents.

*You must continue to pay your Medicare Part B premium.

Doctor Visits (PCP / Specialist)
Maximum Out-of-Pocket Responsibility (does not include prescription drugs)
Part D Prescription Drug (Rx) Yearly Deductible
Preventive Care
Diagnostic X-Ray and Lab Services
Allowance for Grocery
Allowance for Over-the-Counter (OTC) Products
Special Supplemental Benefits for the Chronically Ill (SSBCI)
Preventative Dental Services
Routine Eye Exam
Eyeglasses
Routine Hearing Exam
Hearing Aids
Acupuncture Services
Transportation Services
Worldwide ER Care
Physical Therapy
$0 / $0 copay**
$3,400 annually (Includes copays AND other costs for medical services for the year)
$0 if you receive Extra Help, $615 if you receive no Extra Help
$0 copay**
$0 copay**
One-time $100 allowance*** (allowance expires on March 31, 2027)
$15 allowance per month (allowance expires quarterly)
$45 allowance per month**** (allowance expires at the end of plan year)
$1,000 allowance for Dental Services beyond those covered by Medi-Cal Dental Program
$0 copay** (one exam allowed annually)
$0 copay for one pair of glasses every two years (maximum $150 allowance)
$0 copay
$1,000 annual allowance may be applied towards the purchase price of up to two Entry Level hearing aids each year. Purchases must be made through NationsHearing.
$0 copay**
$0 copay per trip, 48 one-way trips per year**
$0 copay within the U.S., $90 copay outside the US ($25,000 maximum coverage amount)
$0 copay**

*Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive.
Please contact the plan for further details.
**Prior authorization and referral rules may apply.
***Must qualify by completing Annual Wellness Visit.
****Must meet qualification and participation rules.

View the complete Summary of Benefits here

Ready to Enroll?

Complete the enrollment form & return to our Sales Department.

Download Enrollment Form

Still have questions? Get in touch with us.

Call

1-888-681-3888 (TTY 1-877-681-8898)
7 days a week from 8 a.m. to 8 p.m.

Visit

445 Grant Avenue, San Francisco, CA 94108
Monday – Saturday: 9 a.m. – 5 p.m.

845 Jackson Street, San Francisco, CA 94133
Monday – Friday: 9 a.m. – 5 p.m.

386 Gellert Boulevard, Daly City, CA 94015
Monday – Friday: 9 a.m. – 5 p.m.

Email

[email protected]

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Exceptional Member Support

Our approachable and dedicated team of friendly, knowledgeable Member Services representatives are here to answer questions or concerns related to your covered services or the care you receive. Always accessible and ready to assist, you can reach us via email, phone, or even in-person. As our member, we ensure you get the help you need, whenever you need it.

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