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There are nearly two million residents across Santa Clara County, so it comes as little surprise that the county also has a high number of Medicare Advantage (Medicare Part C) beneficiaries.
More than 118,000 residents of Santa Clara County were enrolled in a Medicare Advantage plan in 2019, which accounted for 42% of all Medicare beneficiaries in the county.1
Learn more about Medicare Advantage in California.
|Number of unique plans||14|
|Weighted average premium||$69|
|Average annual deductible||$52.19|
|Average (in-network) out-of-pocket maximum||$5,079|
|Number of $0 premium plans||3|
|Number of plans rated four stars or higher||9|
In 2019, residents of Santa Clara, CA had 14 different plans from which to choose.
Three of those plans featured $0 premiums in 2019, and the weighted average annual deductible for Medicare Advantage plans in the county was just $52.
Nine of the fourteen available plans were rated four stars or higher based on Medicare Star Ratings, which speaks to the quality of selection available in Santa Clara County.2 Plans rated four stars or higher are considered top-rated Medicare plans.
Premiums, deductibles and other costs may vary. The numbers reported in the table above are taken from the Centers for Medicare and Medicaid Services (CMS). A licensed insurance agent will be able to help you review and compare costs for specific plans available in Santa Clara County or wherever you may live.
Medicare Advantage plans can come in several different forms.
All Medicare Advantage enrollees in Santa Clara County – and in the state of California, for that matter – belonged to an HMO plan in 2019.
HMO (Health Maintenance Organization) plans utilize a network of participating doctors and other health care providers. Care is typically not covered by the plan when received outside of the network.
In the state of California, the breakdown of plan types in 2019 was as follows:
|Plan type||Percentage of California enrollees (2019)|
There are different Medicare enrollment periods in the year during which you may able to sign up for a Medicare Advantage plan in Santa Clara County, depending on your eligibility.
When you first become eligible for Medicare, you will typically be granted an Initial Enrollment Period (IEP). This period begins three months before you turn 65 years old, includes the month of your birthday and continues for an additional three months.
The Annual Enrollment Period (AEP, also called the Medicare Open Enrollment Period for Medicare Advantage plans) takes place from October 15 to December 7 each year. This period is open to all eligible Medicare beneficiaries who wish to add, drop or change Medicare plans.
If you experience a qualifying circumstance, you may be granted a Special Enrollment Period (SEP) at any time throughout the year to allow you to enroll in a Medicare Advantage plan.
Such circumstances may include situations like moving outside of your plan’s service area or losing your Medicare Advantage plan coverage through no fault of your own. A licensed insurance agent can help you determine if you are eligible for a Special Enrollment Period and what actions you may be able to take during that time.
Medicare Advantage plans can come in a variety of types and can include different benefits, networks, costs and more.
Connect with a licensed insurance agent today for help determining your eligibility and finding the best Medicare Advantage plan for you in Santa Clara County.
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1 MedicareAdvantage.com's internal analysis of CMS Medicare Advantage landscape source files, accessed May 2019. Data retrieved from www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn.
2 Every year, Medicare evaluates plans based on a 5-star rating system.