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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 2025, 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 2025.
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 $167.00. 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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $30 copay at preferred pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you may have a reduced premium.
Additional Benefits
The Leon MediMore (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays with a copay of $50 for days 1-5 and no copay for days 6-90, along with outpatient services, emergency services, and primary care. Additional benefits include preventive, vision, hearing, and dental services. You'll have no copays for routine eye exams, and no copay for home health services. The plan also provides coverage for hearing exams, prescription hearing aids, and a wide range of dental services, with a maximum benefit of $5250 per year.
Inpatient Hospital See details
Inpatient Hospital coverage with Leon MediMore (HMO) includes a $50 copay for days 1-5, and no copay for days 6-90 for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $50, Observation Services with a $120 copay, Ambulatory Surgical Center (ASC) Services with a $30 copay, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered, but require prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground Ambulance Services have a $100 copay, while Air Ambulance Services have a 20% coinsurance. 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, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay, while Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Services has a $120 copay for Worldwide Emergency Coverage, and a $100 copay for Worldwide Urgent Coverage and a $100 copay and 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
Under the Leon MediMore (HMO) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Mental Health Specialty Services are partially covered, with individual and group sessions not covered.
Preventive Services See details
The Leon MediMore (HMO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, health education, fitness benefits (Memory Fitness), Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Kidney Disease Education Services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. This plan does not cover in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), 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 benefit, 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.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered once every year and once every three years, respectively. Prescription hearing aids are covered with a maximum plan benefit of $1050.00 every three years. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Leon MediMore (HMO) plan covers vision services, including routine eye exams with no copay, and eyewear. Eyewear includes eyeglasses, eyeglass lenses, and eyeglass frames, with a maximum benefit of $320 per year for eyeglasses and $140 per year for contact lenses.
Dental Services See details
The Leon MediMore (HMO) plan covers a range 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. The plan has a maximum benefit of $5250 per year, and orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Leon MediMore (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require both prior authorization and a doctor's referral. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), with a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Additionally, Prosthetics/Medical Supplies - Non-Medicare benefit is covered with no copay or coinsurance, but Prosthetic Devices and Medical Supplies are not covered. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Leon MediMore (HMO) plan, although some services are not covered. There is no copay for any of the covered services. The plan does not cover Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services. Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Leon MediMore (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but some services are not covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Leon MediMore (HMO) plan, requiring prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $20 copay for days 21-100, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Leon MediMore (HMO) plan covers acupuncture with a limit of 6 treatments per year, and requires prior authorization and a doctor referral. This plan also offers an over-the-counter (OTC) items benefit with a maximum coverage amount of $50 every three months, and also offers a meal benefit for chronic illness. Several other services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others.
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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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