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Leon MediExtra (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Leon MediExtra (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Leon MediExtra (HMO) in 2025, please refer to our full plan details page.
Leon MediExtra (HMO) is a HMO plan offered by LMC Family Holdings, LLC available for enrollment in 2025 to people living in Leon MediExtra Miami Dade. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that Leon MediExtra (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Leon MediExtra (HMO).
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 Leon MediExtra (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1000.00 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 Leon MediExtra (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a $40 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you may have a reduced premium. Review the plan's formulary for specific drug coverage details.
Additional Benefits
The Leon MediExtra (HMO) plan offers a range of benefits with varying cost structures. Inpatient hospital stays, outpatient services, and ambulance services are covered, with no copay for ambulance services. Emergency Services have a $50 copay. Primary care, including specialist services, is covered, but some require prior authorization. The plan also includes preventive, vision, dental, and hearing services, with specific limits on coverage and costs. Dental services have a maximum annual benefit of $7,250. Home infusion, dialysis, medical equipment, diagnostic and radiological services, and home health services are also covered, and most have no copay or coinsurance. Additionally, the plan covers acupuncture and offers an over-the-counter (OTC) benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Prior authorization and a doctor's referral are required for these services.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are covered, except for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Leon MediExtra (HMO) plan, but requires both prior authorization and a doctor referral. The specific costs associated with this benefit are not detailed in the provided information.
Ambulance and Transportation Services See details
The Leon MediExtra (HMO) plan covers ambulance services, with no copay or coinsurance, but ground and air ambulance services are not covered. Transportation services to plan-approved health-related locations are covered, with no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Leon MediExtra (HMO) plan. Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $50 copay, and there is no coinsurance.
Primary Care See details
The Leon MediExtra (HMO) plan covers Primary Care Physician Services, Chiropractic Services (with prior authorization), Occupational Therapy Services (with prior authorization and referral, no copay or coinsurance), Physician Specialist Services (with prior authorization and referral), Podiatry Services (with prior authorization), Other Health Care Professional (with prior authorization and referral), Psychiatric Services (with prior authorization and referral), Physical Therapy and Speech-Language Pathology Services (with prior authorization and referral, no copay or coinsurance), Additional Telehealth Benefits (with referral), and Opioid Treatment Program Services (with prior authorization and referral). Individual and Group Sessions for Mental Health Specialty Services and Individual and Group Sessions for Psychiatric Services are not covered.
Preventive Services See details
The Leon MediExtra (HMO) plan covers preventive services, including annual physical exams, health education, fitness benefits (memory fitness), remote access technologies, and kidney disease education services. However, this plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, 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, or counseling services. Glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are also covered.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is covered once every three years. Prescription hearing aids (all types) are covered with a maximum benefit of $1050 per ear every three years, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Leon MediExtra (HMO) plan covers vision services, including routine eye exams, eyewear, and upgrades. Routine eye exams are covered once per year, and eyewear includes eyeglasses, eyeglass lenses, and frames, with specific limits on the number of pairs and maximum coverage amounts.
Dental Services See details
Leon MediExtra (HMO) covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic, preventive, restorative, and adjunctive services. This plan offers a maximum annual benefit of $7,250, with some services like oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatments, and implant services having limitations on the number of visits or periodicity. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Leon MediExtra (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by Leon MediExtra (HMO), but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Leon MediExtra (HMO). There is no copay or coinsurance for Durable Medical Equipment (DME), but Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for covered services.
Home Health Services See details
Home Health Services are covered by the Leon MediExtra (HMO) plan, with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice. This plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
Other Services includes acupuncture, with a limit of 6 treatments per year, and over-the-counter (OTC) items, with a maximum benefit of $70.00 every month. The plan also covers meal benefits for a chronic illness, but does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services.
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