Kaiser Permanente
Avg Star Rating
4.2 ★
Compare & Enroll — Part C & Part D
Compare & Enroll in Medicare Plans in 95401, CA
With 9 Medicare Advantage options from 4 insurers, 95401, CA has limited plan options compared to most areas, suggesting a moderately competitive market. Approximately 78% of local MA plans charge $0 beyond the standard Part B premium, reflecting strong price competition. The 6 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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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
9
Part D Plans
12
Top MA Star
4.5
Top Drug Star
3.5
Medicare Eligibility in 95401, CA
Approximately 5,738 residents (16.1% of the population) in 95401, 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 95401, CA is $96,885 (28.9% 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. 95401, CA's 9 Medicare Advantage plans are predominantly HMO-based (7 HMO vs. 2 PPO), meaning most require referrals and in-network care. 7 plans offer $0 monthly premiums. The average local star rating is 3.7 out of 5, with the top plan earning 4.5 ★.
Top Medicare Advantage Plans in 95401, CA
We organize CMS plan data into separate leaderboards so you can compare based on what matters most to you. Part C premiums in 95401, CA range from $0 to $84/month. Among rated plans, 5 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 P25 (HMO D-SNP) | Kaiser Permanente | 4.5 ★ | $0.00/mo | HMO D-SNP | Enroll |
| Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) | Kaiser Permanente | 4.0 ★ | $24.00/mo | HMO | Enroll |
| Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) | Kaiser Permanente | 4.0 ★ | $83.90/mo | HMO | Enroll |
| Alignment Health My Choice (PPO) | Alignment Health Plan | 4.0 ★ | $0.00/mo | PPO | Enroll |
| Imperial Dynamic Plan (HMO) | Imperial Health Plan Of California, Inc. | 3.5 ★ | $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 |
|---|---|---|---|---|
| Imperial Dynamic Plan (HMO) | Imperial Health Plan Of California, Inc. | $0.00/mo | $296 | 3.5 ★ |
| Kaiser Permanente Dual Complete North P25 (HMO D-SNP) | Kaiser Permanente | $0.00/mo | $9,250 | 4.5 ★ |
| Alignment Health Sutter Advantage +More (HMO) | Alignment Health Plan | $0.00/mo | $4,900 | 3.5 ★ |
| Anthem Dual Advantage 2 (PPO D-SNP) | Anthem Blue Cross Life And Health Insurance Company | $0.00/mo | $9,250 | 2.5 ★ |
| Alignment Health My Choice (PPO) | Alignment Health Plan | $0.00/mo | $4,200 | 4.0 ★ |
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 ★ |
| Imperial Courage Plan (HMO) | Imperial Health Plan Of California, Inc. | $2,999 | $0.00/mo | 3.5 ★ |
| Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) | Kaiser Permanente | $3,900 | $83.90/mo | 4.0 ★ |
| Alignment Health My Choice (PPO) | Alignment Health Plan | $4,200 | $0.00/mo | 4.0 ★ |
Plan Type Mix in 95401, 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 | 5 | 55.6% | Requires referrals; in-network only |
| PPO | 1 | 11.1% | No referrals; in and out-of-network |
| PPO D-SNP | 1 | 11.1% | Medicare Advantage plan |
| HMO D-SNP | 1 | 11.1% | Medicare Advantage plan |
| HMO C-SNP | 1 | 11.1% | 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 95401, 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 95401, CA
4 insurance companies offer Medicare Advantage plans in 95401, 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.
Alignment Health Plan
Avg Star Rating
3.8 ★
Imperial Health Plan Of California, Inc.
Avg Star Rating
3.5 ★
Anthem Blue Cross Life And Health Insurance Company
Avg Star Rating
2.5 ★
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 95401, 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 95401, 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 95401, 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 Value Script (PDP) | Wellcare | 3.5 ★ | $5.70/mo | $615 | Enroll |
| Wellcare Classic (PDP) | Wellcare | 3.5 ★ | $6.20/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 95401, CA
6 insurance companies offer standalone Part D drug plans in 95401, 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 95401, 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 95401, CA
Part D plans have preferred pharmacy networks where you'll pay lower copays. Here's a look at pharmacy options in and around 95401, CA.
Total Pharmacies
28
within 5.0 miles
Chain Pharmacies
11
CVS, Walgreens, etc.
Independent Pharmacies
17
locally owned
| Pharmacy | Address & Phone | Distance | Type |
|---|---|---|---|
| SONOMA COUNTY INDIAN HEALTH PROJECT, INC | 144 STONY POINT RD SANTA ROSA, CA 954014122 707-752-4585 | 0.2 mi | Independent |
| JGS PHARMACIES INC | 1055 W COLLEGE AVE SANTA ROSA, CA 954015059 707-757-1313 | 0.4 mi | Independent |
| LONGS DRUG STORES CALIFORNIA LLC | 463 STONY POINT RD SANTA ROSA, CA 954015900 707-752-7523 | 0.6 mi | Independent |
| THRIFTY PAYLESS INC | 1793 MARLOW ROAD SANTA ROSA, CA 954014474 707-754-8875 | 0.8 mi | Independent |
| SAFEWAY INC | 1799 MARLOW RD SANTA ROSA, CA 954014474 707-752-3730 | 0.8 mi | Chain |
| MARIN APOTHECARIES INC | 751 LOMBARDI CT SANTA ROSA, CA 954076798 707-758-8770 | 1.0 mi | Independent |
| THRIFTY PAYLESS INC | 955 STONY POINT ROAD SANTA ROSA, CA 954074728 707-752-3015 | 1.1 mi | Independent |
| RP HEALTHCARE INC | 2456 W 3RD ST SANTA ROSA, CA 954016425 707-757-5955 | 1.3 mi | Independent |
| GARFIELD BEACH CVS LLC | 950 CODDINGTOWN CTR SANTA ROSA, CA 954013512 707-759-5588 | 1.4 mi | Chain |
| KAISER FOUNDATION HEALTH PLAN INC | 2240 MERCURY WAY SANTA ROSA, CA 95407 707-757-3499 | 1.5 mi | Chain |
Pharmacy data from CMS. Network participation varies by plan—always verify with your specific Part D plan.
Local Healthcare Access in 95401, CA
Before choosing a plan, consider the healthcare infrastructure in 95401, 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
6
within 25.0 miles
Top-Rated Hospitals near 95401, CA
If hospital access matters to your plan choice, check quality ratings before you enroll. These are the highest CMS-rated hospitals near 95401, 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-Santa Rosa | 4 ★ | 2.3 mi | 173 |
| Sutter Santa Rosa Regional Hospital | 4 ★ | 3.6 mi | 170 |
| Petaluma Valley Hospital | 4 ★ | 14.4 mi | 99 |
| Providence Queen Of The Valley Medical Center | 4 ★ | 25.6 mi | 171 |
| Kaiser Foundation Hospital | 4 ★ | 31.9 mi | 120 |
| Kaiser Foundation Hospital And Rehab Center | 4 ★ | 34.7 mi | 475 |
| Sutter Solano Medical Center | 3 ★ | 34.9 mi | 111 |
| Providence Santa Rosa Memorial Hospital | 2 ★ | 2.5 mi | 346 |
| Sonoma Valley Hospital | 1 ★ | 18.6 mi | 83 |
| Healdsburg Hospital | Not Rated | 14.3 mi | 26 |
View all 6 hospitals near 95401, CA to check quality before you enroll →
Hospital data from CMS Hospital Compare and Provider of Services file. Distance calculated from center of 95401, CA.
Telehealth in 95401, 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 95401, 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 95401, CA
Fiber Available
50.6%
of households
Cable/DSL Available
99.5%
of households
Top Provider
Sonic
32.4% coverage
No Broadband
2.6%
of households
Internet coverage data from ISP Reports. View full internet report for 95401, CA.
Medicare-Relevant Demographics in 95401, CA
Understanding 95401, 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
35,564
Population 65+
5,738
16.1% of total
Median Age
41
2.7 years older than the national average
Median Income
$96,885
28.9% above the National Average
On Medicare
5,600
15.7% of residents
On Medicaid
8,446
23.7% of residents
Uninsured
3,423
9.6% of residents
Social Security Recipients
10,138
28.5% of population
Demographic data from U.S. Census Bureau American Community Survey (2023). View full 95401, CA demographics (BestNeighborhood.org).
Local Medicare FAQ: 95401, CA
Common decision points based on 95401, CA's specific plan market and local healthcare landscape.
How does 95401, CA's Medicare Advantage market compare?
95401, CA has 9 Medicare Advantage plans from 4 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 7 HMO and 2 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 95401, CA?
With 6 hospitals nearby, a PPO plan may offer valuable flexibility if your preferred providers aren't all in the same network. HMO plans (7 available) cost less but limit your choices. In 95401, 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 95401, CA?
7 plans (78% of available options) in 95401, 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 95401, CA, maximum out-of-pocket limits range from $296 to an average of $4,566. 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 95401, 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 95401, 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 95401, CA from ispreports.org
- Telehealth.HHS.gov: Official telehealth guidance from U.S. Dept. of Health & Human Services
- BestNeighborhood.org: Community demographic profiles for 95401, 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.