Bay Area · 9 counties · open to everyone
What does my Medicare Advantage plan cost?
Premium, max-out-of-pocket, drug deductible and star rating for each Bay-Area Medicare Advantage plan — plus what it charges for the services that matter at discharge (SNF, home health, DME, therapy, ambulance). Figures are from CMS plan filings for 2026; always confirm with the plan before deciding, and check whether a facility is in-network separately. For programs that help pay, see Who can pay.
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Medi-Cal (managed care)
Medi-Cal managed-care benefits are standardized statewide — most members pay $0 for covered services (SNF, home health, DME, therapy). There is no per-plan cost-share grid to publish. Extra in-home/respite/transition help is available via CalAIM Community Supports — see the “Who can pay” money layer.
Medicare Advantage plans
33 in San MateoAetna Medicare Eagle (PPO)
Aetna Medicare · PPO
Premium / mo
$Not Applicable
Max out-of-pocket
$6,750.00
Drug deductible
$Not Applicable
What it costs at discharge
- Inpatient hospital (acute)
- $430/day days 1–4, $0/day days 5–90
- Skilled nursing facility (SNF)
- $10/day days 1–20, $218/day days 21–100
- Home health
- $0 copay
- Physical / speech therapy
- $20 copay
- Occupational therapy
- $20 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $265 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· Alameda, San Francisco, San Mateo, Santa Clara
Aetna Medicare Enhanced (PPO)
Aetna Medicare · PPO
Premium / mo
$204.00
Max out-of-pocket
$4,900.00
Drug deductible
$615.00
What it costs at discharge
- Inpatient hospital (acute)
- $300/day days 1–7, $0/day days 8–90
- Skilled nursing facility (SNF)
- $10/day days 1–20, $218/day days 21–100
- Home health
- $0 copay
- Physical / speech therapy
- $30 copay
- Occupational therapy
- $30 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $285 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Mateo, Santa Clara
Kaiser Permanente Senior Advantage Basic San Mateo (HMO)
Kaiser Permanente · HMO
Premium / mo
$15.00
Max out-of-pocket
$6,000.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $325/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $150/day days 21–100
- Home health
- $0 copay
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $350 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Mateo
Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO)
Kaiser Permanente · HMO
Premium / mo
$89.00
Max out-of-pocket
$3,900.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $285/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $100/day days 21–100
- Home health
- $0 copay
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $275 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· Marin, San Mateo
Alignment Health Harmony (HMO)
Alignment Health Plan · HMO
Premium / mo
$0.00
Max out-of-pocket
$3,400.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $100/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $100/day days 21–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $200 copay
- Ground ambulance
- $175 copay
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· Alameda, San Francisco, San Mateo, Santa Clara
Alignment Health Honor+ Plan (HMO)
Alignment Health Plan · HMO
Premium / mo
$0.00
Max out-of-pocket
$9,250.00
Drug deductible
$615.00
What it costs at discharge
- Inpatient hospital (acute)
- see plan
- Skilled nursing facility (SNF)
- see plan
- Home health
- $0 — covered in full
- Physical / speech therapy
- 20% coinsurance
- Occupational therapy
- 20% coinsurance
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- 20% coinsurance
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· Alameda, Marin, San Francisco, San Mateo, Santa Clara
Alignment Health My Choice (PPO)
Alignment Health Plan · PPO
Premium / mo
$106.00
Max out-of-pocket
$4,200.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $225/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $160/day days 21–51, $0/day days 52–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $250 copay
- Ground ambulance
- $250 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Mateo, Sonoma
Alignment Health Sutter Advantage +More (HMO)
Alignment Health Plan · HMO
Premium / mo
$48.00
Max out-of-pocket
$4,900.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $275/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $10/day days 1–20, $160/day days 21–51, $0/day days 52–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $250 copay
- Ground ambulance
- $250 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Francisco, San Mateo, Sonoma
Blue Shield Inspire (HMO)
Blue Shield of California · HMO
Premium / mo
$56.00
Max out-of-pocket
$4,500.00
Drug deductible
$425.00
What it costs at discharge
- Inpatient hospital (acute)
- $280/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $200/day days 21–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $15 copay
- Occupational therapy
- $15 copay
- Outpatient hospital services
- $250 copay
- Ground ambulance
- $280 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· Alameda, San Mateo
Kaiser Permanente Dual Complete North P2 (HMO D-SNP)
Kaiser Permanente · HMO D-SNP
Premium / mo
$0.00
Max out-of-pocket
$9,250.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $475/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $214/day days 21–100
- Home health
- $0 copay
- Physical / speech therapy
- $0 copay
- Occupational therapy
- $0 copay
- Outpatient hospital services
- $0 copay
- Ground ambulance
- $400 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Mateo, Santa Clara
Kaiser Permanente Dual Complete North P22 (HMO D-SNP)
Kaiser Permanente · HMO D-SNP
Premium / mo
$0.00
Max out-of-pocket
$9,250.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $475/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $214/day days 21–100
- Home health
- $0 copay
- Physical / speech therapy
- $0 copay
- Occupational therapy
- $0 copay
- Outpatient hospital services
- $0 copay
- Ground ambulance
- $400 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Mateo
SCAN Allied (HMO)
SCAN Health Plan · HMO
Premium / mo
$0.00
Max out-of-pocket
$1,999.00
Drug deductible
$250.00
What it costs at discharge
- Inpatient hospital (acute)
- $200/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $75/day days 21–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $175 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Francisco, San Mateo
SCAN Balance (HMO C-SNP)
SCAN Health Plan · HMO C-SNP
Premium / mo
$0.00
Max out-of-pocket
$1,500.00
Drug deductible
$250.00
What it costs at discharge
- Inpatient hospital (acute)
- $100/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $75/day days 21–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $125 copay
- Ground ambulance
- $180 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· Alameda, San Mateo
SCAN Classic (HMO)
SCAN Health Plan · HMO
Premium / mo
$0.00
Max out-of-pocket
$1,500.00
Drug deductible
$250.00
What it costs at discharge
- Inpatient hospital (acute)
- $100/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $75/day days 21–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $125 copay
- Ground ambulance
- $180 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· Alameda, San Mateo
SCAN MyChoice (HMO)
SCAN Health Plan · HMO
Premium / mo
$0.00
Max out-of-pocket
$1,999.00
Drug deductible
$250.00
What it costs at discharge
- Inpatient hospital (acute)
- $150/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $75/day days 21–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $150 copay
- Ground ambulance
- $105 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· Alameda, San Mateo
SCAN Strive (HMO C-SNP)
SCAN Health Plan · HMO C-SNP
Premium / mo
$0.00
Max out-of-pocket
$9,250.00
Drug deductible
$250.00
What it costs at discharge
- Inpatient hospital (acute)
- see plan
- Skilled nursing facility (SNF)
- see plan
- Home health
- $0 — covered in full
- Physical / speech therapy
- 20% coinsurance
- Occupational therapy
- 20% coinsurance
- Outpatient hospital services
- 20% coinsurance
- Ground ambulance
- 20% coinsurance
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· Alameda, San Francisco, San Mateo, Santa Clara
Imperial Courage Plan (HMO)
Imperial Health Plan of California, Inc. · HMO
Premium / mo
$Not Applicable
Max out-of-pocket
$2,999.00
Drug deductible
$Not Applicable
What it costs at discharge
- Inpatient hospital (acute)
- $150/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $200/day days 21–100
- Home health
- $10 copay
- Physical / speech therapy
- 20% coinsurance
- Occupational therapy
- $10 copay
- Outpatient hospital services
- $200 copay
- Ground ambulance
- $150 copay
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solano, Sonoma
Imperial Dynamic Plan (HMO)
Imperial Health Plan of California, Inc. · HMO
Premium / mo
$0.00
Max out-of-pocket
$296.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $0/day days 1–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $100/day days 21–50, $200/day days 51–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $100 copay
- Ground ambulance
- $150 copay
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solano, Sonoma
Imperial Senior Value (HMO C-SNP)
Imperial Health Plan of California, Inc. · HMO C-SNP
Premium / mo
$0.00
Max out-of-pocket
$296.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $0/day days 1–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $100/day days 21–50, $200/day days 51–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $100 copay
- Ground ambulance
- $150 copay
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solano, Sonoma
Aetna Medicare Signature Extra (HMO-POS)
Aetna Medicare · HMO-POS
Premium / mo
$0.00
Max out-of-pocket
$3,600.00
Drug deductible
$300.00
What it costs at discharge
- Inpatient hospital (acute)
- $325/day days 1–7, $0/day days 8–90
- Skilled nursing facility (SNF)
- $20/day days 1–20, $218/day days 21–100
- Home health
- $0 copay
- Physical / speech therapy
- $0 copay
- Occupational therapy
- $0 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $295 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· Alameda, San Francisco, San Mateo
Anthem Medicare Advantage (HMO-POS)
Anthem Blue Cross · HMO-POS
Premium / mo
$0.00
Max out-of-pocket
$4,900.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $250/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $218/day days 21–100
- Home health
- $0 copay
- Physical / speech therapy
- $25 copay
- Occupational therapy
- $25 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $275 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Mateo
Anthem Prime (HMO-POS)
Anthem Blue Cross Partnership Plan · HMO-POS
Premium / mo
$0.00
Max out-of-pocket
$1,200.00
Drug deductible
$110.00
What it costs at discharge
- Inpatient hospital (acute)
- $250/day days 1–5, $0/day days 6–90
- Skilled nursing facility (SNF)
- $0/day days 1–20, $218/day days 21–100
- Home health
- $0 copay
- Physical / speech therapy
- $10 copay
- Occupational therapy
- $10 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $250 copay
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· Alameda, Marin, San Mateo
CCHP Senior Program (HMO)
CCHP (Chinese Community Health Plan) · HMO
Premium / mo
$21.00
Max out-of-pocket
$3,000.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $0 copay
- Skilled nursing facility (SNF)
- $0/day days 1–20, $110/day days 21–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $15 copay
- Occupational therapy
- $15 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $265 copay
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· San Francisco, San Mateo
CCHP Senior Value Program (HMO)
CCHP (Chinese Community Health Plan) · HMO
Premium / mo
$0.00
Max out-of-pocket
$3,500.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $0 copay
- Skilled nursing facility (SNF)
- $0/day days 1–20, $115/day days 21–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $20 copay
- Occupational therapy
- $20 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $265 copay
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· San Francisco, San Mateo
CareAdvantage (HMO D-SNP)
HEALTH PLAN OF SAN MATEO · HMO D-SNP
Premium / mo
$12.00
Max out-of-pocket
$9,250.00
Drug deductible
$615.00
What it costs at discharge
- Inpatient hospital (acute)
- $1157 copay
- Skilled nursing facility (SNF)
- $0/day days 1–20, $218/day days 21–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- 20% coinsurance
- Occupational therapy
- 20% coinsurance
- Outpatient hospital services
- 20% coinsurance
- Ground ambulance
- 20% coinsurance
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· San Mateo
Central Health Classic Care Plan IV (HMO)
Central Health Medicare Plan · HMO
Premium / mo
$0.00
Max out-of-pocket
$2,499.00
Drug deductible
$100.00
What it costs at discharge
- Inpatient hospital (acute)
- $200/day days 1–6, $0/day days 7–90
- Skilled nursing facility (SNF)
- see plan
- Home health
- $0 copay
- Physical / speech therapy
- $0 copay
- Occupational therapy
- $0 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $0 — covered in full
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Francisco, San Mateo
Central Health Dual Access Plan (HMO D-SNP)
Central Health Medicare Plan · HMO D-SNP
Premium / mo
$0.00
Max out-of-pocket
$9,250.00
Drug deductible
$550.00
What it costs at discharge
- Inpatient hospital (acute)
- see plan
- Skilled nursing facility (SNF)
- see plan
- Home health
- $0 copay
- Physical / speech therapy
- $55 copay
- Occupational therapy
- $35 copay
- Outpatient hospital services
- 20% coinsurance
- Ground ambulance
- 20% coinsurance
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· Alameda, Contra Costa, San Francisco, San Mateo, Santa Clara, Solano
Central Health Embrace Care Plan (HMO C-SNP)
Central Health Medicare Plan · HMO C-SNP
Premium / mo
$0.00
Max out-of-pocket
$1,800.00
Drug deductible
$615.00
What it costs at discharge
- Inpatient hospital (acute)
- $0/day days 1–5, $200/day days 6–9, $35/day days 10–90
- Skilled nursing facility (SNF)
- see plan
- Home health
- $0 copay
- Physical / speech therapy
- $0 copay
- Occupational therapy
- $0 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $0 — covered in full
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Francisco, San Mateo
Central Health Embrace Choice Plan (HMO C-SNP)
Central Health Medicare Plan · HMO C-SNP
Premium / mo
$0.00
Max out-of-pocket
$9,250.00
Drug deductible
$615.00
What it costs at discharge
- Inpatient hospital (acute)
- see plan
- Skilled nursing facility (SNF)
- see plan
- Home health
- $0 copay
- Physical / speech therapy
- $0 copay
- Occupational therapy
- $0 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- 20% coinsurance
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· San Francisco, San Mateo
Central Health Valor Care Plan (HMO)
Central Health Medicare Plan · HMO
Premium / mo
$Not Applicable
Max out-of-pocket
$4,400.00
Drug deductible
$Not Applicable
What it costs at discharge
- Inpatient hospital (acute)
- $150/day days 1–6, $0/day days 7–90
- Skilled nursing facility (SNF)
- see plan
- Home health
- $0 copay
- Physical / speech therapy
- $0 copay
- Occupational therapy
- $0 copay
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $0 — covered in full
- Durable medical equipment (DME)
- $0 — covered in full
Verified · 161d agoCMS plan filing· San Francisco, San Mateo, Santa Clara
Advantage Care (HMO)
Align Senior Care · HMO
Premium / mo
$0.00
Max out-of-pocket
$1,900.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $0 copay
- Skilled nursing facility (SNF)
- $0/day days 1–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $125 copay
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· Alameda, Marin, San Francisco, San Mateo, Santa Clara
Premier Care (HMO I-SNP)
Align Senior Care · HMO I-SNP
Premium / mo
$0.00
Max out-of-pocket
$1,900.00
Drug deductible
$0.00
What it costs at discharge
- Inpatient hospital (acute)
- $0 copay
- Skilled nursing facility (SNF)
- $0/day days 1–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- $0 — covered in full
- Occupational therapy
- $0 — covered in full
- Outpatient hospital services
- $0 — covered in full
- Ground ambulance
- $125 copay
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· Alameda, Marin, San Francisco, San Mateo, Santa Clara
Senior Care (HMO I-SNP)
Align Senior Care · HMO I-SNP
Premium / mo
$12.00
Max out-of-pocket
$9,250.00
Drug deductible
$615.00
What it costs at discharge
- Inpatient hospital (acute)
- $235/day days 1–10, $0/day days 11–90
- Skilled nursing facility (SNF)
- $0/day days 1–100
- Home health
- $0 — covered in full
- Physical / speech therapy
- 20% coinsurance
- Occupational therapy
- 20% coinsurance
- Outpatient hospital services
- 20% coinsurance
- Ground ambulance
- 20% coinsurance
- Durable medical equipment (DME)
- 20% coinsurance
Verified · 161d agoCMS plan filing· Alameda, Marin, San Francisco, San Mateo, Santa Clara
Source: CMS Medicare Advantage / Part D Landscape + Plan Benefit Package filings (a curated set of discharge-relevant benefit categories). Cost-shares can have conditions, day limits, and prior-authorization requirements not shown here — confirm specifics with the plan.