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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 2026, 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 2026.
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 features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 generic and Tier 2 preferred brand drugs, you will pay no copay for one-, two-, or three-month supplies when filled at a preferred pharmacy. If you use a standard pharmacy, Tier 1 drugs carry a copay starting at $5 for a one-month supply, while Tier 2 drugs start at a $20 copay. Tier 3 non-preferred drugs require a $40 copay at preferred pharmacies and a $50 copay at standard pharmacies for a one-month supply. Specialty drugs in Tier 4 require a 33% coinsurance at both preferred and standard pharmacies. Additionally, Tier 5 supplemental drugs are available with no copay at preferred pharmacies and a $10 copay at standard pharmacies for a one-month supply.
Additional Benefits
The Leon MediExtra (HMO) plan offers highly cost-effective medical coverage, featuring no copay and no coinsurance for the vast majority of core healthcare services. This includes zero-cost coverage for inpatient hospital stays, primary and specialist doctor visits, preventive care, and home health services. While most care is free, members should expect a $50 copay for emergency room visits and a 20% coinsurance for dialysis treatments. This plan also stands out for its generous supplemental benefits, which include comprehensive dental care up to a $7,250 annual limit and routine vision and hearing services with no copays. Additionally, members receive valuable extras like unlimited round-trip transportation to plan-approved locations and a $100 monthly reimbursement for over-the-counter items. While some prescription Part B insulin drugs carry a $35 copay, most other additional services require no out-of-pocket costs.
Inpatient Hospital See details
Leon MediExtra (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered, offering unlimited additional days for acute care but excluding coverage for upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
Leon MediExtra (HMO) covers outpatient services, including outpatient hospital, ambulatory surgical center, and outpatient blood services, with no copay and no coinsurance. Outpatient substance abuse services are not covered under this plan, and prior authorization and referrals are required for most covered outpatient benefits.
Partial Hospitalization See details
Leon MediExtra (HMO) covers partial hospitalization services with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Leon MediExtra (HMO) covers some ambulance and transportation services with no copay and no coinsurance, subject to prior authorization. Ground ambulance, air ambulance, and transportation to any health-related location are not covered, but unlimited round-trip medical transport to plan-approved health-related locations is provided.
Emergency Services See details
Leon MediExtra (HMO) covers emergency services with a $50 copay and no coinsurance, which is waived if you are admitted to the hospital within 1 day. Urgently needed services feature no copay or coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $40 copay and no coinsurance.
Primary Care See details
Leon MediExtra (HMO) primary care, specialist, and therapy services are covered with no copay and no coinsurance, including routine podiatry and chiropractic care. While some telehealth and opioid treatment services are covered, other chiropractic services and individual or group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Leon MediExtra (HMO) covers preventive services, including annual physical exams, kidney disease education, and diabetes training, with no copay and no coinsurance. While some supplemental benefits like weight management and in-home safety assessments are not covered, other services such as health education and memory fitness are included at no cost.
Hearing Services See details
Hearing services under Leon MediExtra (HMO) are covered with no copay and no coinsurance, though a referral is required. This benefit includes one routine hearing exam annually and one fitting evaluation every three years, while prescription hearing aids are partially covered up to $1,050 per ear every three years, excluding inner ear, outer ear, over the ear, and over-the-counter hearing aids.
Vision Services See details
Leon MediExtra (HMO) covers vision services with no copay and no coinsurance, requiring referrals and prior authorization for all services. This partially covered benefit includes one routine eye exam per year, with other eye exam services not covered, as well as annual eyewear coverage of up to three pairs of eyeglasses (up to $500) or contact lenses (up to $210).
Dental Services See details
Leon MediExtra (HMO) dental services are partially covered, offering no copay and no coinsurance up to a maximum annual benefit of $7,250, though orthodontics is not covered. Covered services include preventive care, diagnostics, restorative services, and implants, most of which require prior authorization and referrals.
Home Infusion bundled Services See details
Leon MediExtra (HMO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Leon MediExtra (HMO) with no copay and a 20% coinsurance, though prior authorization and a referral are required for these services.
Medical Equipment See details
Leon MediExtra (HMO) covers durable medical equipment (DME) with no copay and no coinsurance, subject to prior authorization and preferred vendor limitations. While some prosthetics, medical supplies, and diabetic equipment services are covered with no copay and no coinsurance, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Leon MediExtra (HMO) covers some diagnostic and radiological services with no copay and no coinsurance, though prior authorization and referrals are required. However, diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Leon MediExtra (HMO) plan with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Leon MediExtra (HMO) with no copay and no coinsurance, meaning some services are covered, though cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Leon MediExtra (HMO) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and a referral are required. Admission is allowed with less than a three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Leon MediExtra (HMO) with no copay and no coinsurance, including chronic illness meal benefits, up to 6 acupuncture treatments per year, and a $100 monthly over-the-counter reimbursement. Specific sub-services, such as Naloxone and other miscellaneous services, are not covered.
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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.
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