Blue Shield 65 Plus (HMO)
Available to residents of San Luis Obispo County, CA for 2026. Contract H0504, plan 039, segment 0.
Plan details
| Monthly drug premium | $0.00 |
|---|---|
| Drug deductible | $425.00Tier 1 and 2 exempt |
| Plan type | Medicare Advantage |
| Contract / plan | H0504-039-0 |
| Offered by | Blue Shield of California |
| Parent organization | California Physicians' Service |
| Formulary drugs | 3,332 |
CMS star ratings
- Overall
- 4 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 4.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H0504 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $5.00 |
| Tier 3 | 25% |
| Tier 4 | 30% |
| Tier 5 | 28% |
Also available in 1 other CA county
Plan facts come from the CMS quarterly prescription drug plan public use files.