at a glance
- Health Net is a private insurance company that sells Medicare Advantage plans.
- The company sells plans in California, Oregon, and Washington.
- Health Net’s Medicare Advantage plans offer additional services that aren’t usually available through original Medicare.
- The company was founded more than 40 years ago and serves more than 3 million members.
Health Net sells Medicare Advantage plans that serve as an alternative to original Medicare. In 2021, Health Net joined the Wellcare company, and Health Net Medicare Advantage plans are now offered in some counties in California, Oregon, and Washington as Wellcare by Health Net.
Medicare Advantage plans are often region-specific, and those from Health Net are no exception. The company offers plans in three states.
By choosing these plans (some of which are premium-free), you may be able to get services original Medicare doesn’t offer, such as vision, hearing, and dental coverage, among others.
Read on to find out more about the available Medicare Advantage plans sold through Health Net.
The following are some examples of Medicare Advantage plans available through Health Net.
Health Net HMO plans
A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage plan Health Net offers.
As a general rule, when you’re a member of an HMO, you’ll experience the greatest cost savings when you choose in-network healthcare providers.
When you sign up for your plan, you’ll receive a list of providers and facilities that contract with Health Net to offer services. While you can still see a doctor who’s out of network, you may pay more for these services.
In addition, you’ll likely choose a primary care doctor who will help you manage your care.
If you need a referral to see a medical specialist, such as an orthopedic doctor, dermatologist, or gastroenterologist, you may need to see your primary care doctor first.
Health Net PPO plans
Health Net also offers some Preferred Provider Organization (PPO) plans. This type of plan is similar in some ways to an HMO in that you can choose to see in-network providers for cost savings.
However, you can also choose out-of-network providers at an established cost.
Another way these plans differ from an HMO is that you aren’t necessarily required to have a referral from your primary care doctor to see a specialist.
Health Net Special Needs Plans
In addition to traditional HMOs, Health Net offers Special Needs Plans (SNPs).
These plans are geared specifically toward people with certain illnesses, such as heart disease or diabetes.
If you have a medical condition that’s covered by an SNP, you may find more coverage, benefits, medications, and provider choices geared toward your specific condition.
Health Net offers these plan types as part of an HMO. Examples of these plans include the Health Net Jade plan, which was created for people diagnosed with diabetes, heart conditions, or chronic heart failure.
Another option is the Health Net Seniority Plus Amber I. This is an SNP geared toward those who are enrolled in Medicaid in addition to Medicare.
Part D is the portion of Medicare that covers prescription drugs. Anyone who’s Medicare-eligible is required to have a certain level of Part D coverage.
Often, Health Net and other insurance companies will incorporate Part D coverage into their Medicare Advantage plans.
This means you’ll pay a single monthly premium to Health Net and receive the medical benefits outlined in your plan as well as prescription drug coverage.
Each Medicare Part D plan has a list of medications it covers. This is called a formulary.
Medicare requires each Part D plan to cover at least two drugs in each major drug category, such as antihypertensives or medications to treat diabetes.
Your plan may further separate medications into tiers such as:
- generic
- preferred
- brand-name
As a general rule, brand-name medications are usually more expensive than preferred or generic options.
Health Net may also contract with preferred pharmacies. If you buy your medications from these pharmacies, you’ll have greater cost savings.
Medicare Advantage plans are usually offered to a specific state or region. This allows companies like Health Net to contract with providers and facilities in the area to offer in-network cost savings to members.
Currently, Health Net offers Medicare Advantage plans in these states:
- California (specifically the counties containing Los Angeles and San Diego)
- Oregon
- Washington
If you live in one of these areas, you can search by ZIP code on Medicare.gov to find out if Health Net offers plans where you live.
Choosing a Medicare Advantage plan can expand the number of services available to you. Examples of these services may include:
- fitness memberships to participating fitness facilities
- hearing aids
- in-home fitness programs
- preventive and comprehensive dental services
- routine eye exams and eyewear
These benefits may vary based on the plan you select.
The following are some examples of Medicare Advantage plans available through Health Net.
| City | Plans | Star rating | Monthly premium | Annual deductible | In-network out-of-pocket max | Primary care visit copay | Specialist visit copay |
|---|---|---|---|---|---|---|---|
| Los Angeles, CA | Wellcare Low Premium (HMO) | 4 | $18 (with drug coverage) | $0 | $2,400 | $0 | $0 |
| San Diego, CA | Wellcare Dual Liberty (HMO D-SNP) | 4 | $0 (with drug coverage) | $0 health deductible /$480 drug deductible | $3,450 | $0 | $0 |
| Salem, OR | Wellcare Giveback Open (PPO) | 3.5 | $0 (with drug coverage) | $0 health deductible /$200 drug deductible | $7550 | $20 | $50 |
| Vancouver, WA | Wellcare Low Premium Open (PPO) | 3.5 | $30 (with drug coverage) | $195 health deductible /$150 drug deductible | $6900 | $15 | $30 |
Medicare Advantage, also known as Medicare Part C, is an alternative to original Medicare. Plans offer all the coverage of original Medicare, plus some added services Medicare doesn’t offer.
You’ll still have to pay your monthly Part B premium, in addition to any Medicare Advantage premium. However, there are some trade-offs.
Original Medicare doesn’t require you to see an in-network provider or obtain specialist referrals. As a result, some people may find Medicare Advantage plans too restrictive.
If a Medicare Advantage plan has a network of providers that you currently see, you may experience fewer challenges compared to original Medicare. Plus, you’ll enjoy extra benefits such as vision, dental, or hearing coverage.
Medicare Advantage plans vary by region. Some areas may have many choices, while others may have fewer than 10. Not all plan types are offered in every region.
Health Net is an insurance company that offers Medicare Advantage plans in certain counties in California as well as regions in Washington and Oregon. Plans offered include:
- PPOs
- HMOs
- SNPs
For more information and to see available Health Net plans in your area, visit the find a Medicare plan tool.