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Health Plan of San Mateo

by: SMCMA AdminApril 25, 2014
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Health Plan of San MateoThe Health Plan of San Mateo (HPSM) is a local non-profit health care plan that offers health coverage and a provider network to San Mateo County's underserved population. HPSM currently serves more than 100,000 County residents.

The County Board of Supervisors established the San Mateo Health Commission in 1986 to address and resolve the issues of poor access to physicians, an uncoordinated health care system endured by the county's growing population of Medi-Cal patients. In 1987, the Commission founded the Health Plan of San Mateo to provide access to a stable and comprehensive network of providers, and a benefits program that promotes preventive care with staff devoted to ensuring Medi-Cal patients receive high quality, coordinated health care.

The Health Plan of San Mateo (HPSM) offers several health programs for residents of San Mateo County who meet eligibility requirements.

  • ACE: Health coverage for adults who do not qualify for Medi-Cal
  • Care Advantage: Medicare & Medi-Cal benefits in one plan
  • Healthy Families: Coverage for children in low-income families who do not qualify for the state Medi-Cal health program.
  • HealthyKids: Coverage for children and teens in low-income families who do not qualify for the state Medi-Cal health program or HPSM's Healthy Families
  • Medi-Cal: Coverage for low-income residents who qualify for the state Medi-Cal plan
  • HealthWorx: Employer health insurance program for specific employee groups in San Mateo County

Click here for a brochure outlining HPSM's programs. The brocure is also available in Spanish, Tagalog, Russian and Chinese on the HPSM website.

ACE

San Mateo County Access and Care for Everyone (ACE) is a coverage program for adults age 19 through 64 who are not eligible for other state and federal insurance programs. ACE is available only to residents of San Mateo County.

ACE covers medically necessary health services for adults only. And it covers services received only at ACE primary care provider clinics and the San Mateo Medical Center, except with prior authorizations.

ACE providers are the San Mateo Medical Center (SMMC), SMMC primary care clinics, and Ravenswood Family Health Center. SMMC primary care clinics are located in Daly City, San Mateo, Redwood City, East Palo Alto, Half Moon Bay, Menlo Park, and South San rancisco. You can go to a non-ACE provider only with a referral from an ACE provider, and with pre-approval from HPSM. If you do not have pre-approval, you will be responsible for the costs of services.

ACE participants are required to pay a participation fee of $240 for one year of coverage, and co-payments for services.One full payment of $240 or monthly payments of $20.Co-pays are required for certain medical services. They are paid directly to the San Mateo Medical Center.

To apply for ACE, visit the Health Coverage Unit website or call 650-616-2002.

Click here for HPSM's ACE Brochure

Care Advantage

HPSM CareAdvantage (HMO SNP) is a Coordinated Care plan with a Medicare Advantage contract and a contract with the California Medicaid program. CareAdvantage combines Medicare & Medi-Cal benefits into one simple plan.

To enroll in CareAdvantage you need to meet all of these requirements:

  • Have Medicare Parts A and B
  • Have full-scope Medi-Cal benefits through the Health Plan of San Mateo
  • Live in San Mateo County
  • Cannot be receiving end-stage-renal dialysis (ESRD) treatment at time of enrollment

There are no monthly premiums. Co-payments for prescription drugs only. Co-pays for range from $0 to $6.35, depending on income, brand or generic drug, and payment stage for drug coverage. You must continue to pay your Medicare Part B premium.

For questions and to apply, call a licensed sales representative at 1-888-252-3153. Click here to apply online.

Healthy Families

Healthy Families provides coverage for children in low-income families who do not qualify for the state Medi-Cal health program. Families must live in San Mateo County.

For questions and to apply, call the San Mateo Health Coverage Unit at 650-616-2002.

Healthy Kids

Healthy Kids is a low-cost health coverage program for children and teens in San Mateo County. It provides health, dental, and vision coverage for children who do not qualify for no-cost Medi-Cal and Healthy Families. Immigration status does not affect eligibility.

A family contribution is paid to HPSM every 3 months (quarterly family contribution) per child. The amount of  the contribution ranges from $12 to $90, based on family size and income. Co-pays are made directly to doctors, pharmacies, and hospitals for services received.

Co-pays for doctor visits, prescription drugs, and emergency services range from $5–$15. No co-pays for immunizations, check-ups, and other visits for prevention.

To apply for Healthy Kids, visit the Children's Health Initiative website or call 650-616-2002. Parents and legal guardians may apply for children.

Click here for HPSM's Healthy Kids Brochure.
 

Medi-Cal

This program is for low-income families, individuals, and children who qualify for the state Medi-Cal health program. Residence in San Mateo County is required.

For questions and to apply: For adults San Mateo Health Insurance Telecenter at 1-800-223-8383.  For children, call the San Mateo Health Coverage Unit  at 650-616 -2002. Click here to apply online.

Click here for a Medi-Cal fact sheet produced by the County of San Mateo's Human Services Agency.

HealthWorx

HealthWorx is an employer health insurance program for three specific employee groups in San Mateo County: Extra Help employees of San Mateo County, In-Home Supportive Services (IHSS) workers for the San Mateo County Public Authority, and certain part-time City of San Mateo employees. Dependents and spouses are not covered.

For questions and to apply:

  • County of San Mateo Extra-Help Employees: Call 650-363-4667
  • San Mateo County Public Authority IHSS Workers SEIU: Call 650-779-9910
  • Certain part-time employees employed by the City of San Mateo: Call 650-779-9910