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Leon MediMax (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Leon MediMax (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 MediMax (HMO D-SNP) in 2026, please refer to our full plan details page.
Leon MediMax (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 MediMax Miami Dade. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Leon MediMax (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 MediMax (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 MediMax (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 MediMax (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 MediMax (HMO D-SNP) Medicare 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 a one-, two-, or three-month supply at both preferred and standard pharmacies. This straightforward cost-sharing structure helps you easily project your out-of-pocket costs for common prescription medications. For Tier 3 non-preferred drugs and Tier 4 specialty tier drugs, the plan charges a 25% coinsurance for a one-month supply at preferred and standard pharmacies. Tier 5 supplemental drugs offer further savings with no copay for a one-month supply at preferred pharmacies, while standard pharmacies require a $10 copay.
Additional Benefits
The Leon MediMax (HMO D-SNP) plan offers comprehensive coverage with no copays, no coinsurance, and no deductibles for almost all of its covered medical services. Members can access essential care including inpatient and outpatient hospital stays, primary and specialist doctor visits, emergency services, and preventive care at no cost. While most of these services require prior authorization or referrals, the plan ensures affordable access to critical healthcare needs. Additionally, the plan provides generous supplemental benefits with no copay, such as up to $5,050 annually for dental care, yearly vision and hearing exams with allowances for corrective wear, and unlimited round-trip medical transportation to approved locations. Members also benefit from a $225 monthly over-the-counter allowance, chronic illness meal delivery, and acupuncture treatments to support overall wellness.
Inpatient Hospital See details
Leon MediMax (HMO D-SNP) partially covers inpatient hospital services with no copay and no coinsurance, although prior authorization and referrals are required. While acute inpatient care includes unlimited additional days, non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Leon MediMax (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. Outpatient substance abuse services also feature no copay and no coinsurance, though only some services are covered as individual and group sessions are not covered.
Partial Hospitalization See details
Leon MediMax (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Members will need to obtain a referral and prior authorization to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Leon MediMax (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Unlimited round-trip medical transport is provided to plan-approved locations, but ground ambulance, air ambulance, and transportation to non-approved locations are not covered.
Emergency Services See details
Leon MediMax (HMO D-SNP) covers emergency, urgently needed, and worldwide emergency services with no copay and no coinsurance. Worldwide coverage includes emergency care, urgent care, and emergency transportation with no maximum plan benefit limits.
Primary Care See details
Leon MediMax (HMO D-SNP) provides primary care, specialist, therapy, and telehealth services with no copay and no coinsurance. Chiropractic, mental health specialty, and psychiatric services are partially covered with no copay and no coinsurance, though other chiropractic services and individual or group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Leon MediMax (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 with no copay and no coinsurance, though excluded services include 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 modifications, and counseling. Prior authorization or referrals are required for select services such as glaucoma screenings and kidney disease education.
Hearing Services See details
Leon MediMax (HMO D-SNP) hearing services are covered with no copay, no coinsurance, and no deductible, though a referral is required. This benefit includes one routine hearing exam per year and up to two prescription hearing aids every three years with a maximum coverage of $1,050 per ear, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Leon MediMax (HMO D-SNP) provides partially covered vision services with no copay and no coinsurance, although other eye exam services are not covered. Covered benefits include one routine eye exam, up to 180 pairs of contact lenses (up to $210 yearly), and up to three pairs of eyeglasses (up to $525 yearly) per year, with prior authorization and referrals required.
Dental Services See details
Dental services are partially covered by Leon MediMax (HMO D-SNP) with no copay and no coinsurance, up to a maximum annual plan benefit of $5,050. While preventive, diagnostic, and comprehensive dental treatments are covered under this plan, orthodontic services are not covered.
Home Infusion bundled Services See details
Leon MediMax (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 covered with no copay or coinsurance, but Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis services are covered by Leon MediMax (HMO D-SNP) with no copay and no coinsurance, although prior authorization and a referral are required for treatment.
Medical Equipment See details
Leon MediMax (HMO D-SNP) covers durable medical equipment with no copay and no coinsurance, though prior authorization is required and preferred vendors apply. Some prosthetic, medical, and diabetic equipment services are covered with no copay and no coinsurance, but 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 by Leon MediMax (HMO D-SNP) with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, specific sub-services including diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays are not covered.
Home Health Services See details
Home Health Services are covered under the Leon MediMax (HMO D-SNP) plan with no copay and no coinsurance. Members must obtain a referral and prior authorization to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Leon MediMax (HMO D-SNP) with no copay and no coinsurance, requiring both a referral and prior authorization. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Leon MediMax (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and referrals are required. The plan allows SNF admission without requiring a prior three-day inpatient hospital stay, but does not cover additional days beyond the standard Medicare-covered benefit.
Other Services See details
Leon MediMax (HMO D-SNP) covers acupuncture, chronic illness meals, and over-the-counter (OTC) items with no copay and no coinsurance. This benefit includes up to 25 acupuncture treatments per year, chronic illness meal delivery, and up to $225 monthly in OTC reimbursements, though other miscellaneous services under this category are not covered.
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* 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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