A non-government entity
L.A. Care Medicare Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for L.A. Care Medicare Plus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on L.A. Care Medicare Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
L.A. Care Medicare Plus (HMO D-SNP) is a HMO D-SNP plan offered by Local Initiative Health Authority for LA County available for enrollment in 2025 to people living in Los Angeles County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that L.A. Care Medicare Plus (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
L.A. Care Medicare Plus (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about L.A. Care Medicare Plus (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For L.A. Care Medicare Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $6.20. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for L.A. Care Medicare Plus (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The L.A. Care Medicare Plus (HMO D-SNP) plan features an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $615.00. During the initial coverage phase, you will pay a 25% coinsurance for Tier 1 through Tier 4 drugs at standard pharmacies and standard mail-order services. This cost-sharing structure applies until your total drug costs reach $2,100.00, at which point you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and enjoy no copay for Medicare Part D covered drugs. Additionally, members who qualify for the low-income subsidy, also known as Extra Help, will have their Part D cost reduced to $6.20.
Additional Benefits
The L.A. Care Medicare Plus (HMO D-SNP) offers comprehensive medical coverage featuring no copays for most outpatient, primary care, emergency, and diagnostic services, though a 20% coinsurance typically applies. Inpatient hospital stays and skilled nursing facility care are also covered, subject to Medicare-defined deductibles, coinsurance, and copays. Preventive services and home health care are fully covered with no copay or coinsurance, helping you manage your health at no extra cost. For specialty care, the plan provides dental benefits with no copay or coinsurance for preventive services, alongside partial vision coverage featuring a $500 eyewear allowance every two years with a 20% coinsurance and no copay. Additionally, members can access up to 45 acupuncture treatments per year and a $110 monthly allowance for over-the-counter items. Routine hearing services and general transportation are not covered under this plan.
Inpatient Hospital See details
L.A. Care Medicare Plus (HMO D-SNP) partially covers inpatient hospital services, requiring prior authorization and Medicare-defined coinsurance and deductibles with no copays. Sub-services such as upgrades, additional days, and non-Medicare-covered stays for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered under L.A. Care Medicare Plus (HMO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, observation, ambulatory surgical center, outpatient blood, and outpatient substance abuse services. Prior authorization and doctor referrals are required for some of these covered benefits.
Partial Hospitalization See details
Partial hospitalization benefits are covered by L.A. Care Medicare Plus (HMO D-SNP) with a 20% coinsurance and no copay. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by L.A. Care Medicare Plus (HMO D-SNP), which covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
L.A. Care Medicare Plus (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay. Worldwide emergency services are partially covered up to a $10,000 limit, but worldwide emergency transportation is not covered.
Primary Care See details
L.A. Care Medicare Plus (HMO D-SNP) covers primary care and additional services, including specialist visits, physical therapy, chiropractic, and mental health care, with no copay and a 20% coinsurance. Certain services under this benefit may require prior authorization or a doctor referral.
Preventive Services See details
L.A. Care Medicare Plus (HMO D-SNP) covers preventive services with no copay or coinsurance, including annual physical exams, kidney disease education, and personal emergency response systems. This benefit is partially covered, as health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling are not covered.
Hearing Services See details
Hearing services are not covered under L.A. Care Medicare Plus (HMO D-SNP) because routine hearing exams, fitting evaluations, prescription hearing aids, and OTC hearing aids are all not covered.
Vision Services See details
Vision services are partially covered under L.A. Care Medicare Plus (HMO D-SNP), offering one annual routine eye exam and eyewear up to a $500 limit every two years with a 20% coinsurance and no copay. While contact lenses and complete eyeglasses are covered, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
L.A. Care Medicare Plus (HMO D-SNP) offers partially covered dental services, with no coverage for maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a 20% coinsurance and no copay, while other covered preventive and comprehensive dental services are available with no copay or coinsurance.
Home Infusion bundled Services See details
L.A. Care Medicare Plus (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs are subject to a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by L.A. Care Medicare Plus (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
L.A. Care Medicare Plus (HMO D-SNP) partially covers medical equipment, requiring prior authorization and a 20% coinsurance with no copay for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
L.A. Care Medicare Plus (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic tests, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to access these benefits.
Home Health Services See details
Home Health Services are covered by L.A. Care Medicare Plus (HMO D-SNP) with no copay and no coinsurance. This benefit requires a doctor referral and prior authorization before services can be received.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by L.A. Care Medicare Plus (HMO D-SNP), but in practice, only some services are covered because cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Consequently, there is no copay or coinsurance coverage available for these services under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by L.A. Care Medicare Plus (HMO D-SNP), requiring prior authorization and a doctor referral, with cost-sharing subject to Medicare-defined copays and coinsurance. While a three-day prior hospital stay is not required for admission, additional SNF days beyond the standard Medicare-covered limit are not covered.
Other Services See details
L.A. Care Medicare Plus (HMO D-SNP) partially covers other services, offering up to 45 acupuncture treatments per year and a $110 monthly allowance for over-the-counter items, though nicotine replacement therapy is excluded. Meal benefits and highly integrated services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved