2027 Medicare Advantage plan in Santa Clara County
DualConnect (HMO D-SNP) in Santa Clara County, CA (2027)
Plan ID H4045-001-0 · Santa Clara Family Health Plan · HMO D-SNP
3 out of 5 stars for 2027
Chat with a licensed advisor to get help comparing plans, confirming doctors, enrollment, and ongoing support.
- Monthly premium
- $7.30
- In-network out-of-pocket max
- $9,850
- Drug deductible
- $700
- Star rating
- 3 of 5
Who can enroll in this plan
This is a Dual Eligible Special Needs Plan (D-SNP). Only people who have both Medicare and Medi-Cal can enroll, and eligibility is verified before enrollment takes effect. Not everyone can enroll in this plan.
Plan Costs
Your plan may include a monthly premium, an annual deductible, and copays or coinsurance for care.
| Service | What You’ll Pay |
|---|---|
| Monthly premium | $7.30 per month |
| In-network out-of-pocket maximum | $9,850 per year |
| Prescription drug coverage | Included |
| Annual drug deductible | $700 per year |
Doctor Costs
What you pay out of pocket to see a primary care doctor or specialist.
| Service | What You’ll Pay |
|---|---|
| Primary care provider (PCP) | 20% of the cost |
| Specialist | 20% of the cost |
| Telehealth | 20% of the cost |
| Other health care professionals | 20% of the cost |
Facility Costs
What you pay out of pocket for care at a hospital, urgent care, or skilled nursing facility.
| Service | What You’ll Pay |
|---|---|
| Outpatient hospital | 20% of the cost |
| Ambulatory surgical center | 20% of the cost |
| Emergency care | 20% of the cost |
| Urgent care | 20% of the cost |
| Ground ambulance | 20% of the cost |
| Air ambulance | 20% of the cost |
Diagnostics
What you pay out of pocket for diagnostic tests, labs, radiology, and x-rays.
| Service | What You’ll Pay |
|---|---|
| Diagnostic tests and procedures | 20% of the cost |
| Lab services | 20% of the cost |
| Diagnostic radiology (such as CT, MRI, PET) | 20% of the cost |
| Therapeutic radiology | 20% of the cost |
| Outpatient x-rays | 20% of the cost |
| Glaucoma screening | 20% of the cost |
| Diabetes monitoring | 20% of the cost |
| Digital rectal exam (prostate screening) | 20% of the cost |
| EKG screening | 20% of the cost |
Vision Care Costs
What you pay out of pocket for vision care, including routine exams and eyewear.
| Service | What You’ll Pay |
|---|---|
| Eye exam (Medicare-covered) | 20% of the cost |
| Eyewear | |
| Eyewear (Medicare-covered) | $0 |
| Contact lenses | $0 |
| Eyeglasses | $0 |
| Combined eyewear allowance | $200 every two years |
Mental Health Care Costs
What you pay out of pocket for mental health and substance use care.
| Service | What You’ll Pay |
|---|---|
| Outpatient | |
| Individual therapy (mental health) | 20% of the cost |
| Group therapy (mental health) | 20% of the cost |
| Individual therapy with a psychiatrist | 20% of the cost |
| Group therapy with a psychiatrist | 20% of the cost |
| Outpatient substance use services, individual | 20% of the cost |
| Outpatient substance use services, group | 20% of the cost |
| Partial hospitalization | 20% of the cost |
| Intensive outpatient services | 20% of the cost |
Therapy Costs
What you pay out of pocket for therapy and rehabilitation services.
| Service | What You’ll Pay |
|---|---|
| Occupational therapy | 20% of the cost |
| Physical therapy and speech therapy | 20% of the cost |
| Cardiac rehabilitation | 20% of the cost |
| Intensive cardiac rehabilitation | 20% of the cost |
| Pulmonary rehabilitation | 20% of the cost |
| Supervised exercise therapy for peripheral artery disease | 20% of the cost |
Additional Services & Treatments
What you pay out of pocket for additional treatment options.
| Service | What You’ll Pay |
|---|---|
| Podiatry (Medicare-covered) | 20% of the cost |
| Opioid treatment services | 20% of the cost |
| Home health care | $0 |
Other Services
What you pay out of pocket for equipment, supplies, and other services.
| Service | What You’ll Pay |
|---|---|
| Durable medical equipment | 20% of the cost |
| Prosthetics, orthotics, and medical supplies | 20% of the cost |
| Diabetes supplies | 20% of the cost |
| Diabetes shoes and inserts | 20% of the cost |
| Diabetes monitors | 20% of the cost |
| Renal dialysis | 20% of the cost |
| Blood (first 3 pints) | 20% of the cost |
| Kidney disease education | 20% of the cost |
Extra Benefits
Benefits that Original Medicare does not cover. Some amounts are allowances the plan pays toward the service.
| Service | What You’ll Pay |
|---|---|
| Over-the-counter (OTC) items allowance | $35 every three months |
| Health education | $0 |
| Fitness benefit | $0 |
| Remote access technologies and nursing hotline | $0 |
Prescription Drugs
What you pay for covered prescription drugs in the initial coverage stage, for a one month supply at a retail pharmacy. Your actual cost depends on the drug and the pharmacy you use.
| Service | What You’ll Pay |
|---|---|
| Annual drug deductible | $700 per year |
| Preferred Generic | 25% of the cost |
| Generic | 25% of the cost |
| Preferred Brand | 25% of the cost |
| Non-Preferred Brand | 25% of the cost |
| Specialty Tier | 25% of the cost |
| Select Care Drugs | $0 |
Costs shown are the in-network costs this plan filed with CMS for covered services. Premiums do not include the Part B premium, which most people pay separately, and do not reflect low-income subsidies. A service that is not listed here is either not covered by this plan or its cost could not be stated plainly from the plan’s filing; we can walk through the plan’s full cost details with you before you enroll.
Star Ratings
- Overall rating
- 3 out of 5 stars
- Health plan rating (Part C)
- 3 out of 5 stars
- Drug plan rating (Part D)
- 3.5 out of 5 stars
Every year, Medicare rates Medicare Advantage and Part D plans on a scale of 1 to 5 stars, based on the quality of care and customer service a plan delivers. CMS publishes these ratings by contract, not by individual plan, so every plan under this contract (H4045) shares the ratings above.
How this plan sits in Santa Clara County
Santa Clara County has 36 Medicare Advantage plans for 2027, and 20 of them have a $0 monthly premium. This plan costs $7.30 per month and caps in-network out-of-pocket costs at $9,850 for the year. Price alone does not tell you whether it keeps your care team, so compare it with the rest of the county before you decide.
What to check before you enroll
Your doctors. Check that your doctors and hospitals take this exact plan, not just this carrier. Networks are set plan by plan and can change each year.
Your prescriptions. Check each prescription against this plan's drug list and its drug deductible, and confirm what your medicines would cost at the pharmacy you use.
Your pharmacy. Confirm your pharmacy is in the plan's network. A pharmacy outside the network can raise what you pay for the same prescription.
Does this plan cover your doctors and prescriptions?
The premium and the out-of-pocket maximum are only half the picture. Run the check against your own doctors, prescriptions, and pharmacy to see what this plan would really cost you. It takes a minute, and Eric follows up with what the check finds, at no cost to you.
Our doctor check for Santa Clara County explains how we verify your care team against a plan before anyone enrolls.
Questions about this plan
What is the monthly premium for DualConnect (HMO D-SNP) in Santa Clara County in 2027?
DualConnect (HMO D-SNP) costs $7.30 per month in Santa Clara County for 2027, on top of your Part B premium.
What is the out-of-pocket maximum for DualConnect (HMO D-SNP)?
The in-network out-of-pocket maximum is $9,850 per year. Once your in-network costs for covered services reach that amount, the plan pays 100 percent of covered in-network costs for the rest of the year.
What is the prescription drug deductible for DualConnect (HMO D-SNP)?
DualConnect (HMO D-SNP) has an annual drug deductible of $700. You pay that amount for covered drugs first, then the plan's drug costs apply.
What is the Medicare star rating for DualConnect (HMO D-SNP)?
CMS rates this plan's contract 3 out of 5 stars for 2027. Star ratings are published by contract, not by individual plan, and they reflect the quality of care and customer service across every plan under the contract.
What do doctor visits cost with DualConnect (HMO D-SNP)?
In-network costs from the plan's CMS filing: Primary care provider (PCP) 20% of the cost; Specialist 20% of the cost; Telehealth 20% of the cost; Other health care professionals 20% of the cost. The Doctor Costs section on this page lists the full set of visit costs.
Who can enroll in DualConnect (HMO D-SNP)?
This is a Dual Eligible Special Needs Plan (D-SNP). Only people who have both Medicare and Medi-Cal can enroll, and eligibility is verified before enrollment takes effect. Not everyone can enroll in this plan. Talk with us first and we will help you check whether you qualify.
How does DualConnect (HMO D-SNP) compare with other 2027 plans in Santa Clara County?
Santa Clara County has 36 Medicare Advantage plans for 2027, and 20 of them have a $0 monthly premium. DualConnect (HMO D-SNP) costs $7.30 per month with an in-network out-of-pocket maximum of $9,850. The right comparison also checks your doctors, prescriptions, and pharmacy, which a premium table cannot show.
Who can help me enroll in DualConnect (HMO D-SNP)?
Eric Ullrich, a licensed independent Medicare agent, can check this plan against your doctors, specialists, and prescriptions, help you compare it with the other plans in Santa Clara County, and walk you through the next steps to enroll, at no cost to you. Call or text 415.617.5402 or start the check from this page.
Speak with a licensed insurance agent
Call or text, Mon to Thu 9 AM to 8 PM, Fri 9 AM to 3 PM, Sat 9 AM to 2 PM PT
Talk through DualConnect (HMO D-SNP) with Eric. We will check your doctors, prescriptions, and pharmacy against this plan and compare it with your other options, at no cost to you. No call center and no pressure.
Plan facts on this page are from the CMS CY2027 Medicare plan landscape data, the CMS Plan Benefit Package (PBP) Benefits 2027 filing, and the CMS 2027 Star Ratings Data Tables (Oct 8, 2026), snapshot generated 2026-10-27. Verify plan details with the plan or at Medicare.gov before enrolling.