Kaiser Permanente
Avg Star Rating
4.2 ★
Compare & Enroll — Part C & Part D
Compare & Enroll in Medicare Plans in 95355, CA
With 38 Medicare Advantage options from 11 insurers, 95355, CA has fewer plan options than the national average, suggesting a highly competitive market where insurers often lower premiums to attract members. Approximately 87% of local MA plans charge $0 beyond the standard Part B premium, reflecting strong price competition. The 7 hospitals within 25.0 miles provide reasonable inpatient access for most plan networks. We've organized the CMS data below to help you cross-reference plan costs, quality ratings, and local provider access. Compare plans below, and when you're ready, enroll directly at Medicare.gov.
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Compare Plans at Medicare.gov →
Data freshness: CMS data as of February 2026 •
ACS data as of 2023 •
Reviewed & approved on 2026-02-16
Reviewed by: Wes Ward, Founder & Data Lead •
View our methodology
Important: We are not affiliated with Medicare or any government agency. This site displays publicly available CMS data to help you compare plans. We do not sell insurance or represent any insurance company. For official enrollment and complete plan information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
Important: Plan availability, benefits, and CMS Star Ratings shown here come directly from CMS public files. Plan details can change—always verify with the insurer and at Medicare.gov.
Part C Plans
38
Part D Plans
12
Top MA Star
4.5
Top Drug Star
3.5
Medicare Eligibility in 95355, CA
Approximately 10,830 residents (16.8% of the population) in 95355, CA are 65 or older and likely Medicare-eligible. Whether you're approaching 65, already enrolled, or a caregiver comparing options, the plan data below is organized to help you evaluate Part C (Medicare Advantage) and Part D (prescription drug) coverage side by side.
The median household income in 95355, CA is $94,782 (26.1% above the National Average), which may affect eligibility for Extra Help with Part D drug costs.
Part C: Medicare Advantage Plans
Medicare Advantage (Part C) replaces Original Medicare through private insurers who bundle hospital, medical, and often drug coverage into a single plan. 95355, CA's 38 Medicare Advantage plans are predominantly HMO-based (32 HMO vs. 6 PPO), meaning most require referrals and in-network care. 33 plans offer $0 monthly premiums. The average local star rating is 3.6 out of 5, with the top plan earning 4.5 ★.
Top Medicare Advantage Plans in 95355, CA
We organize CMS plan data into separate leaderboards so you can compare based on what matters most to you. Part C premiums in 95355, CA range from $0 to $85/month. Among rated plans, 22 plans rated 4+ stars.
Highest CMS Star Ratings
Star Ratings are assigned by CMS based on quality measures including customer service, preventive care, and managing chronic conditions.
| Plan Name | Insurer | Star Rating | Premium | Type | |
|---|---|---|---|---|---|
| Kaiser Permanente Dual Complete North P20 (HMO D-SNP) | Kaiser Permanente | 4.5 ★ | $0.00/mo | HMO D-SNP | Enroll |
| Kaiser Permanente Senior Advantage Basic Stanis (HMO) | Kaiser Permanente | 4.0 ★ | $19.00/mo | HMO | Enroll |
| Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) | Kaiser Permanente | 4.0 ★ | $85.00/mo | HMO | Enroll |
| Sutter Senior Advantage, A Scan Medicare Plan (HMO) | Scan Health Plan | 4.0 ★ | $49.00/mo | HMO | Enroll |
| Scan Classic (HMO) | Scan Health Plan | 4.0 ★ | $0.00/mo | HMO | Enroll |
Lowest Monthly Premium
Lower premiums can save money, but check total costs including deductibles, copays, and MOOP.
| Plan Name | Insurer | Monthly Premium | MOOP | Star Rating |
|---|---|---|---|---|
| Alignment Health Allcare Preferred (HMO) | Alignment Health Plan | $0.00/mo | $1,999 | 3.5 ★ |
| Imperial Dynamic Plan (HMO) | Imperial Health Plan Of California, Inc. | $0.00/mo | $296 | 3.5 ★ |
| Alignment Health Calplusduals (HMO D-SNP) | Alignment Health Plan | $0.00/mo | $9,250 | 3.5 ★ |
| Humana Gold Plus H5619-148 (HMO) | Humana | $0.00/mo | $2,900 | 3.5 ★ |
| Wellcare Health Net Dual Align (HMO D-SNP) | Wellcare | $0.00/mo | $9,250 | 3.5 ★ |
Lowest Maximum Out-of-Pocket (MOOP)
MOOP caps your financial risk. Once you hit this limit, the plan covers 100% of covered services for the rest of the year.
| Plan Name | Insurer | MOOP (In-Network) | Premium | Star Rating |
|---|---|---|---|---|
| Imperial Dynamic Plan (HMO) | Imperial Health Plan Of California, Inc. | $296 | $0.00/mo | 3.5 ★ |
| Imperial Senior Value (HMO C-SNP) | Imperial Health Plan Of California, Inc. | $296 | $0.00/mo | 3.5 ★ |
| Scan Balance (HMO C-SNP) | Scan Health Plan | $750 | $0.00/mo | 4.0 ★ |
| Scan Classic (HMO) | Scan Health Plan | $799 | $0.00/mo | 4.0 ★ |
| Anthem Prime (HMO-POS) | Anthem Blue Cross Partnership Plan | $1,200 | $0.00/mo | 3.0 ★ |
Plan Type Mix in 95355, CA
HMO plans require referrals and in-network care. PPO plans offer more flexibility. SNP (Special Needs Plans) serve specific populations. MAPD plans include drug coverage.
| Plan Type | Count | Percentage | Description |
|---|---|---|---|
| HMO | 15 | 39.5% | Requires referrals; in-network only |
| HMO C-SNP | 11 | 28.9% | Medicare Advantage plan |
| HMO D-SNP | 5 | 13.2% | Medicare Advantage plan |
| PPO | 5 | 13.2% | No referrals; in and out-of-network |
| HMO-POS | 1 | 2.6% | HMO with some out-of-network options |
| PPO C-SNP | 1 | 2.6% | Medicare Advantage plan |
Choosing the Right Medicare Advantage Plan
The best Part C plan depends on your doctors, medications, and budget. Key factors to evaluate:
- Provider network: Verify your doctors and hospitals near 95355, CA are in-network before enrolling
- Total cost: A $0 premium may have higher copays—calculate your annual cost
- Star Ratings: 4+ stars indicate above-average quality and member satisfaction
Read our full guide on choosing Medicare Advantage → · Print our enrollment checklist →
Medicare Glossary: HMO, PPO, MOOP & more →
Medicare Advantage Insurers in 95355, CA
11 insurance companies offer Medicare Advantage plans in 95355, CA. Below, we group plans by insurer so you can compare options from each company. More insurers generally means more competition and better benefits for consumers.
Scan Health Plan
Avg Star Rating
4.0 ★
Plan
Premium
MOOP
Stars
Type
Alignment Health Plan
Avg Star Rating
3.6 ★
Plan
Premium
MOOP
Stars
Type
Humana
Avg Star Rating
3.5 ★
Imperial Health Plan Of California, Inc.
Avg Star Rating
3.5 ★
Blue Shield Of California
Avg Star Rating
3.5 ★
Plan
Premium
MOOP
Stars
Type
Wellcare
Avg Star Rating
3.5 ★
Plan
Premium
MOOP
Stars
Type
Central Health Medicare Plan
Avg Star Rating
3.0 ★
Plan
Premium
MOOP
Stars
Type
Anthem Blue Cross Partnership Plan
Avg Star Rating
3.0 ★
Plan
Premium
MOOP
Stars
Type
Anthem Blue Cross Life And Health Insurance Company
Avg Star Rating
2.5 ★
Plan
Premium
MOOP
Stars
Type
Health Plan Of San Joaquin / Mountain Valley Health Plan Advantage D-Snp (Hmo)
Avg Star Rating
N/A
Plan
Premium
MOOP
Stars
Type
Plan availability, premiums, and benefits shown are based on CMS data and may change. Always verify current details with the insurer and at Medicare.gov before enrolling.
Part D: Prescription Drug Plans (PDP)
Part D covers prescription drugs through standalone plans for those on Original Medicare, or as part of a Medicare Advantage bundle. Among the 12 standalone Part D plans in 95355, CA, some offer $0 annual deductibles while others charge up to the 2026 maximum of $590. 2 plans are at or below the regional premium benchmark, making them eligible for Low Income Subsidy auto-enrollment. The 2026 $2,000 out-of-pocket cap means drug costs are now more predictable regardless of which plan you choose, but formulary coverage still varies significantly—always verify your medications are covered before enrolling.
Part D Formulary Notice: Each Part D plan has its own formulary (list of covered drugs). The same medication may be on different tiers—or not covered at all—depending on the plan. Always check that your specific medications are covered before enrolling.
2026 Out-of-Pocket Cap: Thanks to the Inflation Reduction Act, your total out-of-pocket drug costs are capped at $2,000 per year in 2026. Once you reach this limit, you pay nothing more for covered Part D drugs for the rest of the year. This eliminates the old "donut hole" coverage gap that previously caused higher costs.
Low Income Subsidy (LIS / Extra Help): If you have limited income and resources, you may qualify for Extra Help paying Part D costs. Visit SSA.gov or call 1-800-MEDICARE.
Top Part D Drug Plans in 95355, CA
We organize Part D plans by CMS Star Ratings, premiums, and deductibles so you can find the best fit for your prescription needs. Part D premiums in 95355, CA range from $0 to $228/month. Remember: all Part D plans now cap your annual out-of-pocket drug costs at $2,000 thanks to the Inflation Reduction Act.
Highest CMS Star Ratings (Part D)
Part D Star Ratings measure drug pricing, customer service, member complaints, and pharmacy access.
| Plan Name | Insurer | Star Rating | Premium | Deductible | |
|---|---|---|---|---|---|
| Wellcare Classic (PDP) | Wellcare | 3.5 ★ | $6.20/mo | $615 | Enroll |
| Wellcare Value Script (PDP) | Wellcare | 3.5 ★ | $5.70/mo | $615 | Enroll |
| Silverscript Choice (PDP) | Aetna Medicare | 3.0 ★ | $103.60/mo | $615 | Enroll |
| Humana Premier Rx Plan (PDP) | Humana | 3.0 ★ | $172.90/mo | $0 | Enroll |
| Humana Value Rx Plan (PDP) | Humana | 3.0 ★ | $104.60/mo | $601 | Enroll |
Lowest Monthly Premium
Lower premiums help with monthly cash flow, but check drug tier costs and the deductible.
| Plan Name | Insurer | Monthly Premium | Drug Deductible | Star Rating |
|---|---|---|---|---|
| Healthspring Assurance Rx (PDP) | Healthspring | $0.00/mo | $615 | 2.5 ★ |
| Wellcare Value Script (PDP) | Wellcare | $5.70/mo | $615 | 3.5 ★ |
| Wellcare Classic (PDP) | Wellcare | $6.20/mo | $615 | 3.5 ★ |
| Healthspring Extra Rx (PDP) | Healthspring | $70.60/mo | $615 | 2.5 ★ |
| Silverscript Choice (PDP) | Aetna Medicare | $103.60/mo | $615 | 3.0 ★ |
Lowest Annual Drug Deductible
The deductible is what you pay out-of-pocket before the plan starts covering drug costs. The 2026 maximum Part D deductible is $590. Many plans offer $0 deductible options.
| Plan Name | Insurer | Drug Deductible | Monthly Premium | Star Rating |
|---|---|---|---|---|
| Humana Premier Rx Plan (PDP) | Humana | $0 | $172.90/mo | 3.0 ★ |
| Blue Shield Rx Enhanced (PDP) | Blue Shield Of California | $0 | $227.80/mo | 3.0 ★ |
| Aarp Medicare Rx Preferred From Uhc (PDP) | Unitedhealthcare | $130 | $165.40/mo | 2.0 ★ |
| Humana Value Rx Plan (PDP) | Humana | $601 | $104.60/mo | 3.0 ★ |
| Healthspring Assurance Rx (PDP) | Healthspring | $615 | $0.00/mo | 2.5 ★ |
Understanding drug tiers: Part D plans organize medications into 5 cost tiers — Tier 1 (Preferred Generic) is cheapest; Tier 5 (Specialty) is most expensive. Two plans with the same premium can have very different costs for your drugs depending on tier placement. Learn more about drug tiers →
Choosing the Right Part D Drug Plan
The right Part D plan depends on your specific medications. Key factors to evaluate:
- Formulary: Verify your drugs are covered before enrolling
- Preferred pharmacies: Lower copays at certain locations—check your pharmacy is in-network
- Total annual cost: Premium + deductible + copays for your drugs
Read our full guide on choosing Part D →
What is a formulary? See our Medicare Glossary →
Part D Drug Plan Insurers in 95355, CA
6 insurance companies offer standalone Part D drug plans in 95355, CA. Below, we group plans by insurer.
Wellcare
Avg Star Rating
3.5 ★
Humana
Avg Star Rating
3.0 ★
Blue Shield Of California
Avg Star Rating
3.0 ★
Aetna Medicare
Avg Star Rating
3.0 ★
Plan
Premium
Deductible
Stars
Type
Healthspring
Avg Star Rating
2.5 ★
Unitedhealthcare
Avg Star Rating
2.0 ★
Plan availability, premiums, and benefits shown are based on CMS data and may change. Always verify current details with the insurer and at Medicare.gov before enrolling.
Ready to Enroll in 95355, CA?
Compare plans side-by-side at Medicare.gov or speak with a licensed Medicare specialist.
📋 Print our Medicare Enrollment Checklist — gather your info before you compare.
📅 Enrollment Dates & Deadlines · 🩺 Questions to Ask Your Doctor
Medicare.gov is the official U.S. government site for Medicare. Available 24/7.
Pharmacy Access in 95355, CA
Part D plans have preferred pharmacy networks where you'll pay lower copays. Here's a look at pharmacy options in and around 95355, CA.
Total Pharmacies
38
within 5.0 miles
Chain Pharmacies
17
CVS, Walgreens, etc.
Independent Pharmacies
21
locally owned
| Pharmacy | Address & Phone | Distance | Type |
|---|---|---|---|
| WALGREEN CO. | 3019 FLOYD AVE MODESTO, CA 953559604 209-955-4867 | 0.7 mi | Chain |
| RALEYS | 3020 FLOYD AVE MODESTO, CA 953559604 209-955-6030 | 0.7 mi | Chain |
| THRIFTY PAYLESS INC | 1032 OAKDALE ROAD MODESTO, CA 953554513 209-957-6060 | 1.1 mi | Independent |
| WALGREEN CO | 840 OAKDALE RD MODESTO, CA 953554509 209-957-9075 | 1.3 mi | Chain |
| LONGS DRUG STORES CALIFORNIA LLC | 801 OAKDALE RD MODESTO, CA 953554592 209-952-9430 | 1.4 mi | Independent |
| GIL-JER, INC | 2400 COFFEE RD MODESTO, CA 953552051 209-952-1079 | 1.4 mi | Independent |
| B & B PHARMACY SERVICES LLC | 2020 COFFEE RD MODESTO, CA 953552427 209-952-3367 | 1.4 mi | Independent |
| SUTTER VALLEY HOSPITALS | 1800 COFFEE RD MODESTO, CA 953552705 209-956-7642 | 1.4 mi | Independent |
| WALMART INC. | 1421 COFFEE RD MODESTO, CA 953553170 209-922-5616 | 1.6 mi | Chain |
| WALGREEN CO | 3500 COFFEE RD MODESTO, CA 953551305 209-934-0814 | 1.9 mi | Chain |
Pharmacy data from CMS. Network participation varies by plan—always verify with your specific Part D plan.
Local Healthcare Access in 95355, CA
Before choosing a plan, consider the healthcare infrastructure in 95355, CA. Medicare Advantage plans restrict you to in-network hospitals, so understanding local hospital quality helps you pick the right plan — not just the cheapest one.
Note: The facilities below do not indicate which providers are in-network for any specific plan. Always verify network status with your plan before enrolling.
Hospitals Nearby
7
within 25.0 miles
Top-Rated Hospitals near 95355, CA
If hospital access matters to your plan choice, check quality ratings before you enroll. These are the highest CMS-rated hospitals near 95355, CA — click a hospital name to see its full profile and verify it's in your plan's network.
| Hospital | CMS Rating | Distance | Beds |
|---|---|---|---|
| Kaiser Foundation Hospital Manteca | 4 ★ | 18.4 mi | 251 |
| Sutter Tracy Community Hospital | 4 ★ | 27.0 mi | 82 |
| St Joseph's Medical Center Of Stockton | 4 ★ | 27.6 mi | 335 |
| Dameron Hospital | 3 ★ | 27.1 mi | 211 |
| Memorial Medical Center | 2 ★ | 1.3 mi | 275 |
| Emanuel Medical Center | 2 ★ | 12.7 mi | 354 |
| Doctors Hospital Of Manteca | 2 ★ | 16.2 mi | 73 |
| San Joaquin General Hospital | 2 ★ | 23.5 mi | 152 |
| Stanislaus Surgical Hospital | Not Rated | 0.7 mi | 23 |
| Oak Valley Hospital District | Not Rated | 7.6 mi | 144 |
View all 7 hospitals near 95355, CA to check quality before you enroll →
Hospital data from CMS Hospital Compare and Provider of Services file. Distance calculated from center of 95355, CA.
Telehealth in 95355, CA: Is Your Internet Ready?
Many Medicare Advantage and some Part D plans now include telehealth benefits, making routine check-ins and prescription refills easier from home. But telehealth requires reliable internet—here's a look at connectivity in 95355, CA. For official guidance on virtual visits, see Telehealth.HHS.gov from the U.S. Department of Health & Human Services.
Check Internet Providers at Your Address
Telehealth works best with reliable internet. Use this tool (provided free by ISP Reports) to see what's available at your address.
Opens ISP Reports in a new tab. This is not a paid relationship. Special thank you to ISP Reports for allowing free use of their address tool.
Internet Coverage in 95355, CA
Fiber Available
32.3%
of households
Cable/DSL Available
98.7%
of households
Top Provider
Astound Broadband
0.1% coverage
No Broadband
2.1%
of households
Internet coverage data from ISP Reports. View full internet report for 95355, CA.
Medicare-Relevant Demographics in 95355, CA
Understanding 95355, CA's demographics helps contextualize why insurers offer the plans they do. Areas with more seniors and higher incomes tend to attract more insurer competition, while areas with higher Medicaid enrollment may have more Dual-Eligible Special Needs Plans (D-SNP) available.
Total Population
64,582
Population 65+
10,830
16.8% of total
Median Age
39
1.1 years older than the national average
Median Income
$94,782
26.1% above the National Average
On Medicare
10,429
16.1% of residents
On Medicaid
13,046
20.2% of residents
Uninsured
3,047
4.7% of residents
Social Security Recipients
20,853
32.3% of population
Demographic data from U.S. Census Bureau American Community Survey (2023). View full 95355, CA demographics (BestNeighborhood.org).
Local Medicare FAQ: 95355, CA
Common decision points based on 95355, CA's specific plan market and local healthcare landscape.
How does 95355, CA's Medicare Advantage market compare?
95355, CA has 38 Medicare Advantage plans from 11 insurers. This is below the national average of approximately 57 plans. In areas with fewer competing plans, it's especially important to compare the available options carefully. The local mix includes 32 HMO and 6 PPO plans. Plan availability updates annually during the Medicare Annual Enrollment Period (October 15 – December 7).
Should I choose an HMO or PPO Medicare Advantage plan in 95355, CA?
With 7 hospitals nearby, a PPO plan may offer valuable flexibility if your preferred providers aren't all in the same network. HMO plans (32 available) cost less but limit your choices. In 95355, CA, HMO plans dominate the market, which often means more competitive HMO pricing. Always verify your doctors are in-network before enrolling in any plan.
What's the real cost of $0 premium plans in 95355, CA?
33 plans (87% of available options) in 95355, CA charge $0 beyond the standard Part B premium. This high percentage reflects strong insurer competition in the area. However, $0 premium doesn't mean $0 cost. These plans may have higher copays, coinsurance, or out-of-pocket maximums. In 95355, CA, maximum out-of-pocket limits range from $296 to an average of $5,194. We recommend calculating your total expected annual cost (premium + copays + drug costs) rather than choosing based on premium alone.
How does the 2026 $2,000 drug cap affect 95355, CA beneficiaries?
The Inflation Reduction Act capped annual out-of-pocket drug spending at $2,000 starting in 2025, eliminating the old "donut hole" coverage gap. This applies to all 12 standalone Part D plans in 95355, CA.
What this means locally:
- Cost predictability — No matter which of the 12 Part D plans you choose, your drug costs are capped at $2,000/year
- $0 deductible options — Some local plans offer $0 deductibles, meaning coverage starts immediately
- Low-income options — 2 plans meet the regional benchmark for Extra Help/LIS eligibility
While the out-of-pocket cap standardizes maximum costs, formulary coverage still varies significantly between plans. A drug that costs $5/month on one plan's formulary might cost $50 on another. Always check that your specific medications are covered and compare tier placement before enrolling.
See all Medicare FAQs in our complete guide → · Enrollment checklist →
Medicare Glossary · Enrollment Dates & Deadlines · Doctor Questions
About the Data & Editorial Team
Wes Ward
Founder & Data Lead
Wes Ward is the founder of InsuranceDataNow.org and reviews all content for data accuracy and methodology compliance.
With 25+ years in data analytics — including work with highly regulated genomic data at Ancestry.com — Wes brings enterprise-level rigor to consumer data tools. He is also a co-founder of BestNeighborhood.org, CrimeGrade.org, and ISPReports.org.
Role: Reviews and approves all content for data accuracy, source verification, and methodology compliance.
Transparency & Disclosures
InsuranceDataNow is an advertising-supported publisher based in South Jordan, Utah. We are not affiliated with or endorsed by Medicare or the U.S. government.
TPMO Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (24 hours a day/7 days a week) to get information on all of your options.
Sources
- CMS Medicare Plan Finder Data (Part C & D): cms.gov
- CMS Provider Directory: Hospital and pharmacy data from data.cms.gov
- American Community Survey: Demographic data from census.gov
- FCC Broadband Map: Internet availability data from broadbandmap.fcc.gov
- ISP Reports: Internet provider coverage for 95355, CA from ispreports.org
- Telehealth.HHS.gov: Official telehealth guidance from U.S. Dept. of Health & Human Services
- BestNeighborhood.org: Community demographic profiles for 95355, CA from bestneighborhood.org
All data is sourced from official government databases and trusted third-party providers. Data is updated regularly—see page header for last refresh dates.