PHP, California

Rachel Sakai
AHF Provider

Premium, Maximum Out-of-Pocket Costs, Deductible

Your Monthly Premium


Monthly premium

(You must continue to pay your Medicare Part B premium.)



  • Your monthly plan premium will be more if you are required to pay a lifetime Part D late enrollment penalty for going without other drug coverage that is at least as good as Medicare drug coverage (also referred to as “creditable coverage”) for 63 days or more, , if you enroll in Medicare prescription drug coverage in the future.
  • If you have a higher income, you may have to pay an additional amount each month directly to the government for your Medicare prescription drug coverage.
  • Your monthly premium will be less if you are receiving “Extra Help” with your prescription drug costs.   Please see the 2018 Premium Summary Table for Medicare beneficiaries who get “Extra Help” for information about the plan’s premium if you are receiving “Extra Help” from Medicare.
  • If you do not qualify for 100% premium assistance from Medicare’s “Extra Help” program, you may be eligible for the Medicare Part D Premium Payment Assistance Program (MDPP) from the California AIDS Drug Assistance Program (ADAP).  The MDPP pays Part D premiums for persons living with HIV who are enrolled in both a Medicare plan with Part D coverage, which PHP is, and ADAP.  Learn more about the MDPP.  (By clicking on this link you will be taken to the California ADAP website operated by California Department of Public Health, Division of AIDS, which is not affiliated with AIDS Healthcare Foundation or PHP (HMO SNP).)
Maximum Out-of-Pocket

To protect you, Medicare requires all health plans to limit how much you pay “out-of-pocket” during the year. This limit is called the “maximum out-of-pocket amount.” Once you reach the maximum out-of-pocket amount, you generally pay nothing for covered Part A and Part B services for the rest of the year.



Maximum out-of-pocket amount

Your costs for covered medical services (such as copays) count toward your maximum out-of-pocket amount. Your costs for prescription drugs do not count toward your maximum out-of-pocket amount.


Once you have paid $5,000 out-of-pocket for covered Part A and Part B services, you will pay nothing for your covered Part A and Part B services for the rest of the calendar year.


Part D Deductible


Part D prescription drug deductible



This information is not a complete description of benefits.  Contact the plan for more information.  Limitations, copayments and restrictions may apply.  Benefits, premiums and/or co-payments/coinsurance may change on January 1 of each year.

H5852_4006 2018 021418 Approved