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Leon MediDual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Leon MediDual (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Leon MediDual (HMO D-SNP) in 2026, please refer to our full plan details page.
Leon MediDual (HMO D-SNP) is a HMO D-SNP plan offered by LMC Family Holdings, LLC available for enrollment in 2025 to people living in Leon MediDual Miami Dade. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Leon MediDual (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:
Leon MediDual (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 Leon MediDual (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 Leon MediDual (HMO D-SNP), 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 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 $3450.00 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 MediDual (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 generic and Tier 2 preferred brand drugs, members pay a 20% coinsurance for up to a three-month supply at both preferred and standard pharmacies. For Tier 3 non-preferred drugs and Tier 4 specialty drugs, there is a 25% coinsurance for a one-month supply at either preferred or standard pharmacies. Tier 5 supplemental drugs have no copay for a one-month supply at preferred pharmacies, while standard pharmacies charge a $10 copay.
Additional Benefits
The Leon MediDual (HMO D-SNP) plan offers comprehensive healthcare coverage with no copays, no coinsurance, and no deductibles for most essential services. Members can access inpatient and outpatient hospital stays, emergency and urgent care, primary and specialist doctor visits, and preventive care at no cost. Additionally, critical services like home health, skilled nursing, and dialysis are covered with no out-of-pocket fees. This plan also features valuable supplemental benefits, including comprehensive dental care up to a $5,050 annual limit, hearing aid coverage, and allowances for routine eye exams and eyewear. Members also receive unlimited round-trip medical transportation, acupuncture therapy, and a $75 monthly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Leon MediDual (HMO D-SNP) covers inpatient hospital acute and psychiatric stays with no copay and no coinsurance, subject to prior authorization and referral requirements. While unlimited additional days are covered for acute care, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Leon MediDual (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. Some outpatient substance abuse services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Leon MediDual (HMO D-SNP) covers partial hospitalization with no copay and no coinsurance, although prior authorization and a referral are required.
Ambulance and Transportation Services See details
Leon MediDual (HMO D-SNP) provides unlimited round-trip medical transportation to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered. Some ambulance services are covered with no copay and no coinsurance, but ground and air ambulance services are not covered.
Emergency Services See details
Leon MediDual (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency services, including urgent care and emergency transportation, are also fully covered with no copay, no coinsurance, and no maximum benefit limit.
Primary Care See details
Leon MediDual (HMO D-SNP) covers primary care, specialist visits, physical, occupational, and speech therapies, routine podiatry, routine chiropractic, and telehealth services with no copay and no coinsurance. Although some mental health and psychiatric benefits are covered, individual and group sessions for these services are not covered, and non-routine chiropractic care is also excluded.
Preventive Services See details
Leon MediDual (HMO D-SNP) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered, excluding in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Leon MediDual (HMO D-SNP) covers hearing services with no copay and no coinsurance, though a referral is required for services. This partially covered benefit includes one annual routine hearing exam and up to $1,050 per ear for prescription hearing aids every three years, but OTC hearing aids and inner, outer, or over-the-ear prescription hearing aid types are not covered.
Vision Services See details
Leon MediDual (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible, although referrals and prior authorizations are required. Covered benefits include one routine eye exam per year (other eye exam services are not covered) and annual eyewear allowances of up to $210 for contact lenses and $525 for up to three pairs of eyeglasses.
Dental Services See details
Dental Services are partially covered by Leon MediDual (HMO D-SNP) with no copay and no coinsurance for preventive and comprehensive care up to a $5,050 annual maximum. While most dental treatments are covered, prior authorization and referrals are required, and orthodontic services are not covered.
Home Infusion bundled Services See details
Leon MediDual (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, although prior authorization and step therapy are required. This benefit is partially covered, as Medicare Part B insulin is included with no copay or coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Leon MediDual (HMO D-SNP) covers dialysis services with no copay and no coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
Leon MediDual (HMO D-SNP) covers durable medical equipment with no copay and no coinsurance, though prior authorization is required. While some prosthetic 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
Diagnostic and Radiological Services are covered under Leon MediDual (HMO D-SNP) with no copay and no coinsurance, though referrals and prior authorization are required. Only some services are covered, as diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays are not covered.
Home Health Services See details
Leon MediDual (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Leon MediDual (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, although prior authorization and referrals are required. However, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Leon MediDual (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and referrals are required. Admission is allowed with less than a three-day prior inpatient hospital stay, but additional days beyond standard Medicare coverage are not covered.
Other Services See details
Leon MediDual (HMO D-SNP) covers acupuncture up to 25 treatments per year, chronic illness meal benefits, and up to $75 monthly for over-the-counter items with no copay and no coinsurance. This benefit is partially covered because Naloxone, certain drugs on the CMS OTC list, and other unspecified 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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