Sharp Direct Advantage Medicare Plans for San Diego County Residents

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Sharp Direct Advantage plans

Former employees of Sharp HealthCare plans

City of San Diego retirees (SDPEBA) 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.

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 ➜

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

Other added benefits ➜

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

Find a provider ➜

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

Visit the mail order pharmacy ➜

Choose a Silver&Fit gym near you or select from at-home fitness options.

Find participating gyms and clubs ➜

Talk to a specialist icon used on the website

Talk to a Sharp Direct Advantage licensed sales representative

Attend a free Sharp Direct Advantage seminar

Request a one-on-one appointment

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

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Page Last Updated: 5/24/2019

	2019 Sharp Direct Advantage Gold Card (HMO)	2019 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	$10
Specialist physician visit	$35	$30
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 through 7. $0/day for days 8 and beyond.	$175/day for days 1 through 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	$20	$20
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%
Select Care	$0	$0
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
Select Care	$0	$0

	2019 Sharp Direct Advantage Basic Plan (HMO)	2019 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%
Select Care	$0	$0
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
Select Care	$0	$0

	City of San Diego retirees
Plan overview
Monthly plan premium	$194
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

Sharp Direct Advantage coverage options

Sharp Direct Advantage plans

Former employees of Sharp HealthCare plans

City of San Diego retirees (SDPEBA) 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.