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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 2025, 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 2025.
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 $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 $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) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay coinsurance for your prescriptions, depending on the drug tier and pharmacy. For example, you will pay 20% coinsurance for preferred generic drugs at a preferred pharmacy. For non-preferred drugs, you will pay a $0 copay at a preferred pharmacy and a $10 copay at a standard pharmacy.
Additional Benefits
The Leon MediDual (HMO D-SNP) plan offers comprehensive coverage, including inpatient and outpatient services, with a focus on no copays for emergency services, ambulance services, and home health services. This plan also provides coverage for primary care, preventive services, hearing, vision, dental, and other services like home infusion and dialysis, with specific limits and requirements for prior authorization or referrals. The plan offers a wide variety of benefits, but it is important to note that certain services like diagnostic and radiological services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the Leon MediDual (HMO D-SNP) plan. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, are covered by the Leon MediDual (HMO D-SNP) plan, but individual and group sessions for outpatient substance abuse are not covered. Outpatient blood services include an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Leon MediDual (HMO D-SNP) plan, but requires prior authorization and a doctor's referral. No further cost information is available for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Leon MediDual (HMO D-SNP) plan. All Ambulance Services are covered with no copay and no coinsurance, but ground and air ambulance services are not covered. Transportation Services to a plan-approved health-related location are covered, but 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, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered with no copay and no coinsurance under the Leon MediDual (HMO D-SNP) plan.
Primary Care See details
The Leon MediDual (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services, with some services requiring prior authorization or a referral. Mental health specialty services, individual sessions for psychiatric services, and group sessions for psychiatric services are not covered.
Preventive Services See details
The Leon MediDual (HMO D-SNP) plan covers preventive services, including health education, fitness benefits (memory fitness), remote access technologies, and kidney disease education services. Additional services like In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Hearing Services with the Leon MediDual (HMO D-SNP) plan include routine hearing exams and fitting/evaluation for hearing aids, each with one visit per year and every three years, respectively. Prescription hearing aids (all types) are covered with a maximum plan benefit of $1050 per ear every three years, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Leon MediDual (HMO D-SNP) plan covers vision services, including routine eye exams, eyewear, and upgrades. Routine eye exams are covered once per year, and eyewear includes eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, each with a limit of 3 per year, and contact lenses with a maximum benefit of $210 per year.
Dental Services See details
The Leon MediDual (HMO D-SNP) plan covers a variety of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery, with a maximum plan benefit of $5,000 per year. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Leon MediDual (HMO D-SNP) plan, including Medicare Part B Insulin Drugs; however, Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Leon MediDual (HMO D-SNP) plan, but require prior authorization and a doctor's referral.
Medical Equipment See details
Medical Equipment is covered under the Leon MediDual (HMO D-SNP) plan, with no copay or coinsurance for Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefit, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. This plan requires authorization for these benefits and limits Diabetic supplies and services to those from specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Leon MediDual (HMO D-SNP) plan, but all sub-services are not covered. All Diagnostic services, including Diagnostic Procedures/Tests and Lab Services, are not covered, and all Radiological Services, including Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are not covered.
Home Health Services See details
Home Health Services are covered by the Leon MediDual (HMO D-SNP) plan with no copay and no coinsurance, but require prior authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Leon MediDual (HMO D-SNP) plan, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture is covered with a limit of 25 treatments per year, and requires prior authorization and a doctor referral. The plan covers OTC items up to $75.00 per month, and also includes nicotine replacement therapy. The meal benefit is for a chronic illness and has no maximum coverage amount. Several other services are not covered.
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