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Sharp Direct Advantage Gold Card (HMO)

H5386 - 003 - 0
4 out of 5 stars (4 / 5)

Sharp Direct Advantage Gold Card (HMO) is a Medicare Advantage Plan by Sharp Health Plan.

This page features plan details for 2025 Sharp Direct Advantage Gold Card (HMO) H5386 – 003 – 0 available in Sharp Direct Advantage Gold San Diego County.

Locations

Sharp Direct Advantage Gold Card (HMO) is offered in the following locations.

California
San Diego County, California

Click to see more locations

Plan Overview

Sharp Direct Advantage Gold Card (HMO) offers the following coverage and cost-sharing.

Insurer:Sharp Health Plan
Health Plan Deductible:$0
MOOP:$2,900 In-network
Drugs Covered:Yes

Ready to sign up for Sharp Direct Advantage Gold Card (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Sharp Direct Advantage Gold Card (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Sharp Direct Advantage Gold Card (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Sharp Direct Advantage Gold Card (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Diagnostic procedures/lab services/imaging

  • Lab services
    • $0 copay (Authorization Required, Referral Required)
  • Diagnostic radiology services (e.g., MRI)
    • $0-75 copay (Authorization Required, Referral Required)
  • Diagnostic tests and procedures
    • 15% coinsurance (Authorization Required, Referral Required)
  • Outpatient x-rays
    • $10 copay (Authorization Required, Referral Required)

Doctor visits

  • Primary
    • $5 copay per visit
  • Specialist
    • $20 copay per visit (Authorization Required, Referral Required)

Emergency care/Urgent care

  • Emergency
    • $90 copay per visit (always covered)
  • Urgent care
    • $30 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • $30 copay (Authorization Required, Referral Required)

Ground ambulance

    • $155 copay

Health plan deductible

    • $0

Hearing

  • Hearing aids OTC
    • $0 copay (Limits Apply, Authorization Required)
  • Medicare-Covered Hearing Exam
    • $5 copay (Authorization Required, Referral Required)
  • Fitting/evaluation
    • $5 copay (Limits Apply, Authorization Required, Referral Required)
  • Hearing aids
    • $0 copay (Limits Apply, Authorization Required)

Inpatient hospital coverage

    • $225 per day for days 1 through 7
      $0 per day for days 8 through 90 (Authorization Required, Referral Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $2,900 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • $0 copay (Authorization Required)

Medicare Part B drugs

  • Other Part B drugs
    • 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit with a psychiatrist
    • $20 copay (Authorization Required, Referral Required)
  • Inpatient hospital – psychiatric
    • $250 per day for days 1 through 7
      $0 per day for days 8 through 90 (Authorization Required, Referral Required)
  • Outpatient group therapy visit
    • $20 copay (Authorization Required, Referral Required)
  • Outpatient individual therapy visit
    • $20 copay (Authorization Required, Referral Required)
  • Outpatient individual therapy visit with a psychiatrist
    • $20 copay (Authorization Required, Referral Required)

Optional supplemental benefits

    • Yes

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $20-225 copay per visit (Authorization Required, Referral Required)

Preventive care

    • $0 copay (Authorization Required, Referral Required)

Rehabilitation services

  • Occupational therapy visit
    • $20 copay (Authorization Required, Referral Required)
  • Physical therapy and speech and language therapy visit
    • $20 copay (Authorization Required, Referral Required)

Skilled Nursing Facility

    • $0 per day for days 1 through 20
      $125 per day for days 21 through 41
      $0 per day for days 42 through 100 (Authorization Required, Referral Required)

Transportation

    • Not covered

Vision

  • Eyeglass lenses
    • $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply)
  • Other
    • Not covered
  • Eyeglass frames
    • $0 copay (Limits Apply)
  • Routine eye exam
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Upgrades
    • Not covered
  • Contact lenses
    • $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Delta Dental Medicare Advantage PPO for Sharp Health Plan

Comprehensive Dental

  • Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, Prosthodontics, fixed, Oral and Maxillofacial Surgery, Adjunctive General Services
    • Monthly Premium: $40.00
    • Max Coverage: $3000.00
    • Coverage Periodicity: Every year

Diagnostic and Preventive Dental

  • Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services
    • Monthly Premium: $40.00
    • Max Coverage: $3000.00
    • Coverage Periodicity: Every year

Ready to sign up for Sharp Direct Advantage Gold Card (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Table of Contents

Get Help Enrolling

Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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