Individual plans

We offer three Sharp Direct Advantage® plans for San Diego County residents.

Our Medicare Advantage plans for individuals provide comprehensive medical services plus added benefits like vision, hearing, dental and free health coaching.

To join, you must:

  • Be eligible for Medicare Part A and Part B
  • Reside in San Diego County
  

2023 plans

Explore next year's plans below. If you need to enroll in a plan by December, please see our 2022 plans.

 VIP Plan
(HMO)
Gold Card (HMO)Platinum Card (HMO)
Plan overview
Monthly plan premium$0$0$58
Deductible$0
Annual out-of-pocket maximum$2,900 yearly limit for services you receive from in-network providers
Doctor visits
Primary care physician visit$0$5$5
Specialist visit$0$20$20
Preventive care$0
Lab services / X-rays$0 / $10$0 / $10$0 / $0
Diagnostic radiology (e.g., MRIs)$75$7515% of the cost
Hospital visits and emergencies
Inpatient hospital coverage

$225/day for days 1–7

$0/day for days 8 +

$150/day for days 1–8. 

$0/day for days 9 +

Outpatient hospital coverage$0–100$20–225$20–$175
Emergency care$90
Urgently needed services$30 ($90 for worldwide urgent care and emergency coverage)
Supplemental benefits
Dental$0$13 monthly premium$0
Routine eye exam (every 12 months)$0$0$0
Hearing aids$3,000 allowance every 36 months$3,000 allowance every 36 months$3,500 allowance every 36 months
Silver&Fit® Fitness Benefit$0$0$0
Chiropractic care$10, limit 30 visits per year (combined)$10, limit 30 visits per year (combined)$10, limit 30 visits per year (combined)
Acupuncture
Over-the-counter (OTC) itemsUp to $100 per quarterUp to $100 per quarterUp to $125 per quarter
Medicare Part D drugs: initial coverage
Retail: 1-month supply 
   Tier 1 (Preferred Generic)$2
   Tier 2 (Generic)$8
   Tier 3 (Preferred Brand)$40
   Tier 4 (Non-preferred Brand)$95
   Tier 5 (Specialty)33% of the cost
   Tier 6 (Select Care) 
question mark iconIncludes select generic drugs.
$0
Mail order: 3-month supply 
   Tier 1 (Preferred Generic)$0
   Tier 2 (Generic)$0
   Tier 3 (Preferred Brand)$80
   Tier 4 (Non-preferred Brand)$190
   Tier 5 (Specialty)Not offered
   Tier 6 (Select Care) 
question mark iconIncludes select generic drugs.
$0

Rated 5 out of 5 stars for 2023

Sharp Health Plan earned a 5 out of 5 overall star rating for 2023 from the Centers for Medicare and Medicaid Services (CMS).

Every year, Medicare evaluates plans based on a 5-star rating system.

Medicare rated 5 out of 5 stars

Gold and platinum ID cards

The Sharp Experience is your Medicare advantage

 

You may see Sharp HealthCare doctors. But the only way to ensure you have The Sharp Experience from coverage to care is with a Sharp Direct Advantage plan, only from Sharp Health Plan.

 

Switch to San Diego’s 5-star Medicare Advantage plan

Sharp Health Plan is accepting enrollments all year, thanks to the 5-star special enrollment period. Enjoy direct access to Sharp HealthCare and The Sharp Experience.*

Sign up today

* Every year, Medicare evaluates plans based on a 5-star rating system. You can use Medicare’s 5-star special enrollment period to switch from your current Medicare plan to a Medicare plan with a 5-star quality rating. You can use this special enrollment period only once between Dec. 8, 2022, and Nov. 30, 2023.

 

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: 10/14/2022
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