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Plan Comparison Details

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Monthly Premium Out-of-pocket Maximum Emergency Room PCP/Specialist Copay Hospital Copay Rx 30 Day CoPay Rx 30 Day CoInsurance Details Compare Apply 10/15 View Comparison View Comparison Clear Close Print Return to Plans Self Enroll Short Form Add Enhanced Benefits: Option Added Add Option Not Available Best viewed in landscape Rotate your device for the best view 1 selected plan 2 selected plans 3 selected plans 4 selected plans Option A (+$55/mo) Option B (+$60/mo) Option C (+$52/mo) Dental & Vision coverage Dental, Vision, Hearing, Transportation & Meals Dental, Vision, Hearing, Transportation & Meals
This optional supplemental benefit includes dental and vision coverage:
Dental coverage is through Delta Dental Medicare Advantage Network for Aspire Health Plan in Monterey County, CA and includes:
  • Preventive co-pay: $0
  • Comprehensive co-insurance: 20% – 50%
  • Plan pays up to $2,000 every year
Vision coverage is through VSP Vision Care and includes:
  • Yearly routine eye exam: $10 co-pay
  • Eyewear: $25 co-pay.
  • $150 allowance for frames or contacts
This optional supplemental benefit includes dental, vision, hearing, additional transportation, home-delivered meals:
Dental coverage is through Delta Dental Medicare Advantage Network for Aspire Health Plan in Monterey County, CA and includes:
  • Preventive co-pay: $0
  • Comprehensive co-insurance: 20% – 50%
  • Plan pays up to $2,000 every year
Vision coverage is through VSP Vision Care and includes:
  • Yearly routine eye exam: $10 co-pay
  • Eyewear: $25 co-pay.
  • $150 allowance for frames or contacts
Hearing coverage is through TruHearing and includes:
  • Yearly routine hearing exam: $20 co-pay
  • Hearing aids: $599 or $899 / hearing aid
Transportation includes:
  • Additional 10 one-way rides to in-network appointments: $0
Home-delivered meals includes:
  • 14 refrigerated meals, 2 meals per day for 7 days, customized to the member's preference: you pay $0 co-pay
  • Meal benefit must be requested within 14 days of an inpatient hospital stay or following surgery
This optional supplemental benefit includes dental, vision, hearing, additional transportation, home-delivered meals:
Dental coverage is through Delta Dental Medicare Advantage Network for Aspire Health Plan in Monterey County, CA and includes:
  • Comprehensive co-insurance: 20% – 50%
  • Plan pays up to $2,000 every year
Vision coverage is through VSP Vision Care and includes:
  • Yearly routine eye exam: $10 co-pay
  • Eyewear: $25 co-pay.
  • $150 allowance for frames or contacts
Hearing coverage is through TruHearing and includes:
  • Yearly routine hearing exam: $20 co-pay
  • Hearing aids: $599 or $899 / hearing aid
Transportation includes:
  • Additional 10 one-way rides to in-network appointments: $0
Home-delivered meals includes:
  • 14 refrigerated meals, 2 meals per day for 7 days, customized to the member's preference: you pay $0 co-pay
  • Meal benefit must be requested within 14 days of an inpatient hospital stay or following surgery
Benefit Information Important Information HMO Provider Network Prescription Drug Coverage Part D - Prescription Drug Coverage Retail Pharmacy Mail Order Pharmacy, 90-Day Supply Inpatient Care Doctor Office Visits Outpatient Care Outpatient Medical Services Additional Benefits Enhanced Benefits (Optional Add-Ons) Emergency Services Lab Services and Diagnostic Tests Medical Equipment and Supplies Rehabilitation Services Part B Drugs Wellness Exams and Screenings Vision Hearing Monthly Plan Premium
Out-of-Pocket Spending Limitfor Part A & B services
Out-of-service area Health Plan Deductible Drug Deductible Drug Copay Drug Coinsurance Emergency Room Provider Network Details Part B Insulin Copay Other Part B Coinsurance Initial Coverage Threshold
Retail Tier 1: Preferred Generic 30-day supply / 90-day supply
Retail Tier 2: Generic30-day supply / 90-day supply
Retail Tier 3: Preferred Brand30-day supply / 90-day supply
Retail Tier 4: Non-Preferred Drugs 30-day supply only
Retail Tier 5: Specialty Tier 30-day supply only
Retail Tier 6: Select Care Drugs 30-day supply / 90-day supply
Catastrophic Coverage* Once you've spent $2,400 out-of-pocket in 2027, you pay nothing for covered Part D drugs.
Mail Order Tier 1: Preferred Generic Mail Order Tier 2: Generic Mail Order Tier 3: Preferred Brand Mail Order Tier 4: Non-preferred Drug Mail Order Tier 5: Specialty Tier Mail Order Tier 6: Select Care Drugs Inpatient Hospital Inpatient Hospital Inpatient Hospital Skilled Nursing Facility (SNF) Skilled Nursing Facility (SNF) Primary Care Physician (PCP) Visit Specialist Visit Podiatry Services Telehealth
Durable Medical Equipmentper item
Prosthetic Devicesof the cost
Diabetic Supplies Diagnostic Tests & X-Rays Therapeutic Radiology Lab Services Outpatient X-ray Diagnostic Radiology Preventive Services
Annual Gym Membership (exclusively at the Montage Wellness Center)
Transportation To in-network appointments Covered visits per year (one-way trips) Acupuncture Medicare-covered benefits Covered visits per year Routine care Covered visits per year Chiropractic Services Medicare-covered benefits Routine care (limited to specific treatment codes) Covered visits per year Chiropractic (per routine visit) Dental Preventive services Home health services Outpatient mental health, outpatient substance abuse
Urgently needed care (waived if admitted within 24 hours)
Emergency care (waived if admitted within 24 hours)
Ambulance, ground Diagnostic tests and procedures Lab services and X-rays
Durable Medical Equipment (DME) per item
Diabetes — monitoring, supplies, and therapeutic shoes Speech, physical, occupational, cardiac Pulmonary therapy Chemotherapy Part B insulin All other Part B drugs Medicare-covered preventive services Influenza vaccine (1 per year) Medicare-covered Part B vaccines Mammogram (1 per year) Diagnostic screenings (Medicare-covered benefits) Diagnostic hearing exams (Medicare-covered benefits) Outpatient hospital surgery/ambulatory surgical center
Option A
Dental & Vision coverage +$55/month
Option B
Dental, Vision, Hearing, Transportation & Meals +$60/month
Option C
Dental, Vision, Hearing, Transportation & Meals+$52/month
This plan does not have a deductible. In-network only Not Covered Not available
POS provider network. Choose an in-network PCP; out-of-service area care allowed outside Monterey County (US/territories) for Medicare-covered services with Medicare-eligible practitioners.
Combined In/Out Network in-network $130 Copay. If you are admitted to the hospital within 24 hours, the Copay is waived. $25 Copay. If you are admitted to the hospital within 24 hours, the Copay is waived 20% of the cost (hospital) / $300 Copay (ambulatory surgical center) $0 Preventive Dental with Option month
$0 in and out of service area
$0 in and out of service area
$130 in and out of service area
$350 in and out of service area
$0/12 visits In network, 30% Out of network $0 In Network, 30% Out of network

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April 1 to September 30
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Aspire Health Plan is an HMO plan sponsor with a Medicare contract. Enrollment in Aspire Health Plan depends on contract renewal. This information is not a complete description of benefits. Contact us for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Medicare beneficiaries may also enroll in Aspire Health Plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

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Page last updated: October 10, 2026

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