SDPEBA Medicare retirees - Sharp Direct Advantage, San Diego

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SDPEBA retirees plan

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As a City retiree who is eligible for Medicare, you get comprehensive medical services plus added benefits like vision, hearing, dental and free health coaching.

Membership in SDPEBA San Diego Public Employee Benefit Association is San Diego Municipal Employees Association (MEA), City of San Diego Retired Employees' Association (REA), or Retired Fire and Police Association of San Diego (RFPA) is not required to join.

To join, you must:

	Be eligible for Medicare Part A and Part B
	Reside in San Diego County
	Be a City of San Diego retiree or dependent
	Not have end-stage renal disease

	2019–20 Sharp Direct Advantage (HMO)	2020–21 Sharp Direct Advantage (HMO)
Plan overview
Monthly plan premium	$201	$201
Deductible	$0	$0
Annual out-of-pocket maximum (medical)	$1,500	$1,500
Doctor visits
Preventive care	$0	$0
Primary care physician visit	$10	$10
Specialist physician visit	$10	$10
Lab services / x-rays	$0	$0
Diagnostic radiology (e.g., MRIs)	$0	$0
Hospital visits and emergencies
Urgently needed services	$10	$10
Emergency room (waived if admitted to hospital)	$50	$50
Hospitalization	$0/day	$0/day
Outpatient surgery	$50	$50
Supplemental benefits
Routine eye exam	$20	$20
Hearing aids	$1,000 allowance every 36 months	$1,000 allowance every 36 months
Silver&Fit	$0	$0
Chiropractic care	$10, limit 30 visits per year (combined)	$10, limit 30 visits per year (combined)
Acupuncture	$10, limit 30 visits per year (combined)	$10, limit 30 visits per year (combined)
Prescription drug coverage
30-day retail prescription drugs
Preferred generic / generic	$10 / $10	$10 / $10
Preferred brand / non-preferred	$20 / $20	$20 / $20
Specialty / Select Care Includes select generic drugs.	25% of the cost / $0	25% of the cost / $0
90-day mail prescription drugs
Preferred generic / generic	$20 / $20	$20 / $20
Preferred brand / non-preferred	$40 / $40	$40 / $40
Specialty / Select Care Includes select generic drugs.	Not offered / $0	Not offered / $0

Rated 4.5 out of 5 stars by Medicare for 2020.

Sharp Health Plan earned a 4.5 out of 5 overall star rating for 2020 from the Centers for Medicare and Medicaid Services (CMS), and achieved a 5-Star score for ratings of the health plan, health care quality, drug plan and care coordination. Every year, Medicare evaluates plans based on a 5-star rating system.

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Get more from Medicare with our Sharp Direct Advantage plan. You'll have access to our family of Sharp HealthCare providers and receive benefits such as free gym access and more. Learn about The Sharp Direct Advantage^® difference ➜

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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.

H5386_2020 website

Page Last Updated: 6/01/2020

April – September:	Mon. – Fri.
October – March:	7 days a week

City of San Diego retirees (SDPEBA)

SDPEBA retirees plan