Sharp Advantage Medicare plans available to San Diego County residents

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Sharp Direct Advantage plans

Former employees of Sharp HealthCare plans

City of San Diego retirees (SDCERS-MEA) plan

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We're here to make finding and enrolling in the right plan simple. Whether you have never purchased Medicare health coverage or are considering switching from your current plan, we are committed to making your health care experience affordable, accessible and personal.

At Sharp Health Plan, we offer Medicare plans you can feel good about.

	If you're Medicare eligible, there's a good chance you could save money and get better coverage by choosing Sharp Direct Advantage.
	Sharp Direct Advantage provides added benefits, comprehensive prescription drug coverage and much more.
	With Sharp Direct Advantage, you'll have access to doctors, hospitals and medical groups across San Diego County.
	There are two Sharp Direct Advantage plans available to choose from.

	2018 Sharp Direct Advantage Gold Card (HMO)	2018 Sharp Direct Advantage Platinum Card (HMO)
Plan overview
Monthly plan premium	$0	$66
Deductible	None	None
Annual out-of-pocket maximum	$3,400	$3,300
Doctor visits
Preventive care	$0	$0
Primary Care Physician visit	$10	$15
Specialist physician visit	$35	$35
Lab services	$5	$5
Diagnostic radiology (e.g., MRIs)	20%	15%
X-Ray	$10	$10
Hospital visits and emergencies
Urgently needed services	$30	$30
Emergency room	$100	$100
Ambulance	$275	$250
Hospitalization	$260/day for days 1-7. $0/day for days 8 and beyond	$175/day for days 1-8. $0/day for days 9 and beyond
Outpatient surgery	$250	$175
Skilled nursing facility	$0/day for days 1-20. $160/day for days 21-41. $0/day for days 42-100	$0/day for days 1-20. $155/day for days 21-41. $0/day for days 42-100
Durable medical equipment	20%	15%
Dental premium	$11	$0
Routine eye exam	$0	$0
Hearing aids	$2,500 allowance every 36 months	$2,500 allowance every 36 months
Silver and fit	$0	$0
Prescription drug coverage
30-day retail prescription drugs
Generic	$4	$4
Non-preferred	$8	$8
Preferred brand	$47	$47
Non-preferred brand	$100	$100
Specialty	33%	33%
90-day mail prescription drugs
Preferred generic	$0	$0
Generic	$0	$0
Preferred brand	$94	$94
Non-preferred drug	$200	$200
Specialty	Not Offered	Not Offered

2018 Enrollment Kit

Choose a Silver&Fit gym near you or select from at-home fitness options. Find participating clubs at silverandfit.com.

Find participating gyms and clubs ➜

Receive routine eye exams and $105 for contact lenses or $95 for frames every two years through participating VSP providers.

Find a provider ➜

Gold Card and Platinum Card members can order their generic maintenance drugs (Tier 1 and Tier 2) for a $0 copay through our mail order pharmacy, PPSRx.com.

Visit the mail order pharmacy ➜

Gold Card and Platinum Card members have a $0 copay for covered diabetic testing supplies.

Other added benefits ➜

Choose a Silver&Fit gym near you or select from at-home fitness options. Find participating clubs at silverandfit.com.

Find participating gyms and clubs ➜

Receive routine eye exams and $105 for contact lenses or $95 for frames every two years through participating VSP providers.

Find a provider ➜

Members of the Sharp HealthCare employer group plan get up to 20 medically necessary chiropractic visits ($10 copay) per year through American Specialty Health network providers.

Find a provider ➜

Members of the Sharp HealthCare employer group plans pay just a $5 copay for Primary Care Physician (PCP) visits.

Find a provider ➜

Choose a Silver&Fit gym near you or select from at-home fitness options. Find participating clubs at silverandfit.com.

Find participating gyms and clubs ➜

Receive routine eye exams and $130 for frames or contact lenses every two years through participating VSP providers.

Find a provider ➜

Members of the MEA-SDCERS employer group plan get up to 30 medically necessary chiropractic visits ($10 copay) per year through American Specialty Health network providers.

Find a provider ➜

Sharp Direct Advantage members have another option for routine care locally and around the country. Members of the MEA-SDCERS employer group plan pay just a $10 copay to visit MinuteClinic. No appointment is necessary.

Find a pharmacy ➜

We have several physician groups from which to choose your Primary Care Physician (PCP). You then receive specialty care and access to hospitals and urgent care centers from the providers affiliated with the Plan Medical Group you select.

SEARCH DOCTORS ➜

Prescription drug coverage is included in Sharp Direct Advantage to help cover the cost of the medications that your doctor prescribes. Search the drug list to find out if your medication will be covered under Sharp Direct Advantage.

SEARCH DRUG LIST ➜

There is a lot to consider when looking for a Medicare Advantage health plan. Learn about the four parts of Medicare coverage and the added benefits of choosing a Medicare Advantage Plan like Sharp Direct Advantage.

LEARN MORE ➜

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Talk to a Sharp Direct Advantage licensed sales representative

Attend a free Sharp Direct Advantage seminar

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Request a one-on-one appointment

Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Direct Advantage is an HMO plan with a Medicare contract. Enrollment in Sharp Direct Advantage depends on contract renewal. Read the full disclaimer.

H5386_2018 Website Rev1 Approved 1/29/2018

Page Last Updated: 3/02/2018

Sharp Direct Advantage coverage options

Sharp Direct Advantage plans

Former employees of Sharp HealthCare plans

City of San Diego retirees (SDCERS-MEA) plan

Is your doctor covered?

Is your medication covered?

Do you have questions about Medicare?

	If you're Medicare eligible, there's a good chance you could save money and get better coverage by choosing Sharp Direct Advantage.
	With Sharp Direct Advantage, you'll receive added benefits, comprehensive prescription drug coverage and much more.
	With Sharp Direct Advantage, you'll have access to doctors, hospitals and medical groups across San Diego County.

	2018 Sharp Direct Advantage Basic Plan (HMO)	2018 Sharp Direct Advantage Premium Plan (HMO)
Plan overview
Monthly plan premium	$0	$59
Deductible	None	None
Annual out of pocket maximum	$3,400	$3,400
Doctor visits
Preventive Care	$0	$0
Primary care physician visit	$5	$5
Specialist physician visit	$20	$10
Lab services	$5	$0
Diagnostic Radiology (e.g. MRIs)	10%	5%
X-Ray	$5	$0
Hospital visits and emergencies
Urgently needed services	$25	$10
Emergency room	$50	$50
Ambulance	$200	$200
Hospitalization	$125/day for days 1-5. $0/day for days 6 and beyond.	$50/day for days 1-6. $0/day for days 7 and beyond.
Outpatient surgery	$150	$50
Skilled nursing facility	$0/day for days 1-20. $150/day for days 21-57. $0/day for days 58-100	$0/day for days 1-20. $75/day for days 21-48. $0/day for days 49-100
Durable medical equipment	20%	15%
Dental premium	$11	$11
Routine eye exam	$20	$20
Hearing aids	$1,000 allowance Every 36 months	$1,000 allowance Every 36 months
Silver and fit	$0	$0
Prescription drug coverage
30-day retail prescription drugs
Generic	$2	$2
Non-preferred	$6	$6
Preferred brand	$40	$40
Non-preferred brand	$90	$90
Specialty	33%	33%
90-day mail prescription drugs
Preferred generic	$4	$4
Generic	$12	$12
Preferred brand	$80	$80
Non-preferred drug	$180	$180
Specialty	Not Offered	Not Offered

	City of San Diego retirees
Plan overview
Monthly plan premium	$179
Deductible	None
Annual out of pocket maximum	$1,500
Doctor visits
Preventive Care	$0
Primary care physician visit	$10
Specialist physician visit	$10
Lab services	$0
Diagnostic Radiology (e.g. MRIs)	$0
X-Ray	$0
Hospital visits and emergencies
Urgently needed services	$10
Emergency room	$50
Ambulance	$0
Hospitalization	$0/day
Outpatient surgery	$50
Skilled nursing facility	$0/day
Durable medical equipment	$0
Routine eye exam	$20
Hearing aids	$1,000 allowance every 36 months
Silver and fit	$0
Prescription drug coverage
30-day retail prescription drugs
Preferred generic	$10
Non-preferred generic	$10
Preferred brand	$20
Non-preferred brand	$20
Specialty	25%
90-day mail prescription drugs
Preferred generic	$20
Non-preferred generic	$20
Preferred brand	$40
Non-preferred brand	$40
Specialty	Not Offered