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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 2025, 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 2025.
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 $29.70. 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 $590.00 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:
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Drug Coverage
The L.A. Care Medicare Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, the plan's premium is $29.70. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The L.A. Care Medicare Plus (HMO D-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services, emergency services, and primary care with a 20% coinsurance for many services. Preventive services like annual physical exams have no copay. This plan also includes coverage for vision and dental services, along with hearing exams, all with coinsurance. Additional benefits include home health services with no copay, and coverage for medical equipment with coinsurance. Other services like acupuncture and OTC items are also covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare stays, and upgrades for both are not covered. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1, with coinsurance and deductible details available in the plan documents.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, while ASC services and outpatient substance abuse services have a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by L.A. Care Medicare Plus (HMO D-SNP), including ground and air ambulance services, each with a 20% coinsurance, and no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered under the L.A. Care Medicare Plus (HMO D-SNP) plan. Emergency and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services have a maximum benefit coverage of $10,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the L.A. Care Medicare Plus (HMO D-SNP) plan. The coinsurance for Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services is 20%. The coinsurance for Occupational Therapy Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Routine Foot Care, Other Health Care Professional, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Opioid Treatment Program Services is 20%.
Preventive Services See details
The L.A. Care Medicare Plus (HMO D-SNP) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services include Personal Emergency Response System (PERS), In-Home Support Services, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services under the L.A. Care Medicare Plus (HMO D-SNP) plan is partially covered, with a coinsurance of at most 20% for hearing exams, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and eyewear also has a 20% coinsurance with a combined maximum of $500 every two years.
Dental Services See details
The L.A. Care Medicare Plus (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with a 20% coinsurance for Medicare Dental Services. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs and Medicare Part B Chemotherapy/Radiation Drugs, but require prior authorization. The coinsurance for these services varies, with a minimum of 0% and a maximum of 20% for Medicare Part B Chemotherapy/Radiation Drugs.
Dialysis Services See details
Dialysis Services are covered under the L.A. Care Medicare Plus (HMO D-SNP) plan, but require prior authorization and a doctor referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered with no copay. For Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you pay coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the L.A. Care Medicare Plus (HMO D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the L.A. Care Medicare Plus (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. The plan does not cover additional days beyond Medicare-covered for SNF, nor does it cover non-Medicare-covered stays for SNF.
Other Services See details
Under "Other Services," L.A. Care Medicare Plus (HMO D-SNP) covers acupuncture, with a limit of 45 treatments per year. The plan also covers over-the-counter (OTC) items, up to $120.00 per month. However, meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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