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Leon MediMore (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Leon MediMore (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Leon MediMore (HMO) in 2026, please refer to our full plan details page.
Leon MediMore (HMO) is a HMO plan offered by LMC Family Holdings, LLC available for enrollment in 2025 to people living in Leon MediMore Miami Dade. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Leon MediMore (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 MediMore (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 MediMore (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. Additionally, this plan comes with a Part B Premium reduction of $185.00. You must continue to pay paying your reduced 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 $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 MediMore (HMO) prescription drug plan offers excellent value with a $0 drug deductible, allowing your coverage to begin immediately. For Tier 1 generic drugs, there is no copay when filled at a preferred pharmacy, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 preferred brand drugs are available for a $30 copay at preferred pharmacies and a $40 copay at standard pharmacies. For Tier 3 non-preferred drugs, you will pay a $40 copay at preferred locations and a $50 copay at standard locations for a one-month supply. Tier 4 specialty drugs require a 33% coinsurance at both preferred and standard pharmacies. Additionally, Tier 5 supplemental drugs feature no copay at preferred pharmacies and a $10 copay at standard pharmacies.
Additional Benefits
Leon MediMore (HMO) offers comprehensive healthcare coverage with no copays or coinsurance for primary care, specialist visits, and telehealth services. For hospital care, members pay a $50 daily copay for the first five days of inpatient stays, while outpatient services range from no copay to a $50 copay. Emergency room visits require a $120 copay that is waived upon admission, and urgent care is provided with no copay. Supplemental benefits include dental services with no copay up to a generous $5,250 annual limit, alongside routine eye and hearing exams with no copays. Members also receive a $320 annual allowance for eyeglasses, a $50 monthly over-the-counter reimbursement, and unlimited round-trip medical transportation at no cost. Durable medical equipment and dialysis services are covered with no copay and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Leon MediMore (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $50 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization and referrals are required, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Leon MediMore (HMO) covers outpatient hospital services with no copay to a $50 copay and observation services with a $120 copay, both with no coinsurance. Ambulatory surgical center services require a $30 copay with no coinsurance, outpatient blood services have no copay, coinsurance, or deductible, and while some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
Leon MediMore (HMO) covers partial hospitalization with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
Leon MediMore (HMO) covers ground ambulance services with a $100 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are partially covered, providing unlimited round-trip medical transport to plan-approved locations with no copay or coinsurance, while transport to other health-related locations is not covered.
Emergency Services See details
Leon MediMore (HMO) covers emergency services with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services have no copay or coinsurance, while worldwide emergency and urgent care require a $100 copay and no coinsurance, with worldwide emergency transportation requiring a $100 copay and 20% coinsurance.
Primary Care See details
Leon MediMore (HMO) provides primary care, specialist visits, therapy, and telehealth services with no copay and no coinsurance. Chiropractic care is partially covered as other chiropractic services are not covered, while some mental health and psychiatric services are covered but individual and group sessions are not covered.
Preventive Services See details
Leon MediMore (HMO) preventive services are partially covered with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, and memory fitness. However, several additional preventive services are not covered, including 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-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Leon MediMore (HMO) with no copay, no coinsurance, and no deductible, although a referral is required for care. Covered benefits include one routine hearing exam annually and fitting evaluations, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Leon MediMore (HMO) with no copays, no coinsurance, and no deductibles, though prior authorization and referrals are required. The plan covers one routine eye exam per year—excluding other eye exam services—and provides annual allowances of up to $320 for two pairs of eyeglasses and $140 for contact lenses.
Dental Services See details
Leon MediMore (HMO) offers partially covered dental services with no copay and no coinsurance for covered benefits, up to a maximum annual benefit of $5,250. Preventive and comprehensive services such as cleanings, exams, and implants are covered, but orthodontic services are not covered.
Home Infusion bundled Services See details
Leon MediMore (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Leon MediMore (HMO) with no copay and a 20% coinsurance, although prior authorization and a referral are required.
Medical Equipment See details
Leon MediMore (HMO) covers durable medical equipment with no copay and 0% to 20% coinsurance under prior authorization. For non-Medicare prosthetics, medical supplies, and diabetic equipment, some services are covered with no copay and no coinsurance, but prosthetic devices, medical supplies, diabetic supplies, and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Leon MediMore (HMO) covers diagnostic and radiological services with prior authorization and referrals required. Some diagnostic services are covered with no copay and no coinsurance, but diagnostic procedures, tests, and lab services are not covered. Radiological services feature no copay, but diagnostic radiological and outpatient x-ray services are not covered, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Leon MediMore (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required to receive care.
Cardiac Rehabilitation Services See details
Leon MediMore (HMO) technically covers Cardiac Rehabilitation Services with no copay and no coinsurance, but in practice, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Leon MediMore (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $20 daily copay for days 21 through 100. Prior authorization and referrals are required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Leon MediMore (HMO) covers select other services with no copay and no coinsurance, including up to 6 acupuncture treatments per year, chronic illness meal benefits, and a $50 monthly over-the-counter reimbursement. Naloxone and other miscellaneous services are not covered under this benefit, and prior authorization and referrals are required for acupuncture.
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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.
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