Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
TotalCare, 2027
H5692Contract001Plan
HMO D-SNP · special needs plan, dual-eligible · 5 counties in California
Run by Santa Cruz Monterey Merced San Benito Mariposa Managed Medical Care Commission (contract H5692), sold as Central California Alliance for Health, owned by SANTA CRUZ MONTEREY MERCED SAN BENITO MARIPOSA MAN
TotalCare (H5692-001) costs $7.30 a month in 2027, up $1.80 from 2026, with an in-network out-of-pocket limit of $9,850 ($9,250 in 2026).
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Monthly premium | $5.50 | $7.30 | ▲up $1.80 |
| In-network out-of-pocket limit | $9,250 | $9,850 | ▲up $600 |
| Drug deductible | $615 | $700 | ▲up $85 |
| Eyewear, yearly limit | $175 a year | $100 a year | ▼down $75 |
| Drug tier 1, preferred generic | $0 | 25% of the cost | changed |
| Drug tier 4, non-preferred drug | 30% of the cost | 25% of the cost | ▼down 5 points |
| 16 lines do not change | |||
| Part B premium reduction, monthly | none | none | no change |
| Primary care visit | 20% of the cost | 20% of the cost | no change |
| Specialist visit | 20% of the cost | 20% of the cost | no change |
| Emergency room | 20% of the cost | 20% of the cost | no change |
| Medical deductible, in network | none | none | no change |
| Hospital stay, in network | not filed | not filed | no change |
| Skilled nursing facility, in network | not filed | not filed | no change |
| Ground ambulance, in network | 20% of the cost | 20% of the cost | no change |
| Comprehensive dental, yearly limit | not offered | not offered | no change |
| Hearing aids, yearly limit for both ears | not offered | not offered | no change |
| Over-the-counter items, yearly | $400 a year | $400 a year | no change |
| Counties served | 5 | 5 | no change |
| Drug tier 2, generic | 25% of the cost | 25% of the cost | no change |
| Drug tier 3, preferred brand | 25% of the cost | 25% of the cost | no change |
| Drug tier 5, specialty tier | 25% of the cost | 25% of the cost | no change |
| Drug tier 6, select care drugs | $0 | $0 | no change |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026 | 2027 |
|---|---|---|---|
| Tier 1 | Preferred Generic | $0 | 25% of the cost |
| Tier 2 | Generic | 25% of the cost | 25% of the cost |
| Tier 3 | Preferred Brand | 25% of the cost | 25% of the cost |
| Tier 4 | Non-Preferred Drug | 30% of the cost | 25% of the cost |
| Tier 5 | Specialty Tier | 25% of the cost | 25% of the cost |
| Tier 6 | Select Care Drugs | $0 | $0 |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 3 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 2 the same. On the premium, 2 plans have a lower premium.
Out-of-pocket limits of the 3 dual-eligible special needs plans
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
The premium and the out-of-pocket limit are the same in all 5 counties: $7.30 a month and $9,850.
California
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Who runs this plan?
- Plan ID
- H5692-001
- Legal name of the contract
- Santa Cruz Monterey Merced San Benito Mariposa Managed Medical Care Commission
- Sold as
- Central California Alliance for Health
- Parent company
- SANTA CRUZ MONTEREY MERCED SAN BENITO MARIPOSA MAN
- Plan type
- HMO D-SNP
- 2026 star rating of the contract
- not rated (too new) overall; health plan not rated, drug plan not rated
- Members, September 2026
- 1,094
- Plan website, as filed with CMS
- www.thealliance.health/totalcare
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Monterey, CAWhere most of its members live; premiums and limits side by side
- Every Central California Alliance for Health plan for 2027Its contracts, counties and plans that end
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.