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Leon MediPlus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Leon MediPlus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Leon MediPlus (HMO) in 2025, please refer to our full plan details page.
Leon MediPlus (HMO) is a HMO plan offered by LMC Family Holdings, LLC available for enrollment in 2025 to people living in Leon MediPlus Miami Dade. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that Leon MediPlus (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 MediPlus (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 MediPlus (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 MediPlus (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $40 at a preferred pharmacy and $47 at a standard pharmacy. For standard generic drugs, the copay is $60 at a preferred pharmacy and $70 at a standard pharmacy. Preferred brand drugs have a 33% coinsurance. Non-preferred drugs have a $0 copay at a preferred pharmacy and a $10 copay at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Leon MediPlus (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $50 copay for days 1-5, and no copay for days 6-90. Emergency services have a $100 copay, while other services such as ambulance, home health, medical equipment, and diagnostic services have no copay. This plan also covers a variety of services with copays or coinsurance, including primary care, hearing, vision, and dental. Hearing exams and prescription hearing aids are covered, with a maximum hearing aid benefit of $1050 per ear every three years. Vision includes routine eye exams and eyewear with a maximum benefit of $500 for eyeglasses and $210 for contact lenses. Dental services are covered up to a $2,750 annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits under the Leon MediPlus (HMO) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and a doctor's referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, you will pay a $50 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, are covered; however, individual and group sessions for outpatient substance abuse are not covered. Prior authorization and a doctor referral are required for all covered services, and the plan waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by Leon MediPlus (HMO) with prior authorization and a doctor referral required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Leon MediPlus (HMO) plan. All Ambulance Services are covered with no copay or coinsurance, while Ground and Air Ambulance Services are not covered; Transportation Services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by Leon MediPlus (HMO). Emergency Services and Worldwide Emergency Coverage have a $100 copay, while Urgently Needed Services has no copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation each have a $100 copay.
Primary Care See details
The Leon MediPlus (HMO) 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. Individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered by Leon MediPlus (HMO). Health education, fitness benefits, and remote access technologies are covered; however, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services with the Leon MediPlus (HMO) plan include hearing exams and prescription hearing aids, with a doctor referral required. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids are covered once every three years; both of these services do not have a deductible. Prescription hearing aids have a maximum plan benefit coverage of $1050 per ear every three years, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Leon MediPlus (HMO) plan covers vision services, including routine eye exams with no deductible, and eyewear including eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. The plan covers one routine eye exam per year and allows for 3 pairs of eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames per year, with a maximum benefit coverage of $500.00 for eyeglasses (lenses and frames) and $210.00 for contact lenses.
Dental Services See details
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, are covered, with a maximum benefit of $2,750 per year. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Leon MediPlus (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Leon MediPlus (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME), are covered with no copay and no coinsurance. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Leon MediPlus (HMO), but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the Leon MediPlus (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Leon MediPlus (HMO) plan, with a $20 copay for days 1-20 and no copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Leon MediPlus (HMO) plan covers acupuncture with a limit of 6 treatments per year, but requires prior authorization and a doctor's referral. This plan also offers over-the-counter (OTC) items with a monthly maximum benefit of $50, including Nicotine Replacement Therapy, but does not cover Naloxone or all drugs on the CMS OTC list. Additionally, the plan provides a meal benefit for chronic illnesses. However, the plan does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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