A non-government entity
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 2025, 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 2025.
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 $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:
Sign up for Leon MediMax (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Leon MediMax (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible is met, you will pay coinsurance for your prescriptions depending on the drug tier and pharmacy. In the initial coverage phase, you will pay 20% to 26% coinsurance for generic drugs and 25% coinsurance for preferred brand drugs. Non-preferred drugs have a $0 or $10 copay, depending on the pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Leon MediMax (HMO D-SNP) plan offers a variety of benefits with no copay, including ambulance services, emergency services, transportation to health-related locations, home health services, and diagnostic and radiological services. This plan also covers primary care services, preventive services, and outpatient services, with specific limits and exclusions for certain services, like mental health and substance abuse sessions. Additional benefits include coverage for hearing, vision, and dental services, with annual limits and specific coverage details for each. The plan provides coverage for home infusion, dialysis, medical equipment, cardiac rehabilitation, and skilled nursing facility services, but requires prior authorization and doctor referrals for some of these services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization and a doctor referral. Additional Days for Inpatient Hospital-Acute is covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient substance abuse services are covered, however individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Leon MediMax (HMO D-SNP) plan, but requires prior authorization and a doctor referral. The plan does not specify any cost information, such as copay or coinsurance, for this benefit.
Ambulance and Transportation Services See details
The Leon MediMax (HMO D-SNP) plan covers all ambulance services with no copay or coinsurance, but ground and air ambulance services are not covered. Transportation services to plan-approved health-related locations are covered, with no copay or coinsurance, and are unlimited round trips via medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by Leon MediMax (HMO D-SNP), with no copay and no coinsurance.
Primary Care See details
The Leon MediMax (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Occupational therapy and physical therapy have no copay or coinsurance, while individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
The Leon MediMax (HMO D-SNP) plan covers preventive services, including annual physical exams, health education, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams (1 per year) and fitting/evaluation for hearing aids (1 every three years). Prescription hearing aids (all types) are covered with a maximum plan benefit of $1050.00 per ear every three years; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Leon MediMax (HMO D-SNP) plan covers vision services, including routine eye exams, with a limit of one exam every year, and eyewear, including eyeglasses (lenses and frames), eyeglass lenses and eyeglass frames, with a limit of 3 pairs every year and a maximum coverage amount of $525.00, as well as contact lenses with a maximum of 180 pairs every year and a maximum coverage amount of $210.00.
Dental Services See details
Dental services are covered, with a yearly maximum of $2,500. Oral exams, dental x-rays, and prophylaxis (cleaning) are limited to 1 visit every six months, while fluoride treatment and implant services are limited to 1 visit per year. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Leon MediMax (HMO D-SNP) plan, including Medicare Part B Insulin Drugs, but Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required, and the plan offers step therapy from Part B to Part D.
Dialysis Services See details
Dialysis Services are covered under the Leon MediMax (HMO D-SNP) plan, but require prior authorization and a doctor referral. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Prosthetics/Medical Supplies have no copay or coinsurance, but Durable Medical Equipment for use outside the home, 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 MediMax (HMO D-SNP), but none of the listed sub-services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. There is no copay for these services.
Home Health Services See details
Home Health Services are covered by the Leon MediMax (HMO D-SNP) plan, with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Leon MediMax (HMO D-SNP) covers Cardiac Rehabilitation Services, but does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or 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, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. A doctor referral and prior authorization are required.
Other Services See details
The Leon MediMax (HMO D-SNP) plan covers acupuncture with a limit of 25 treatments per year, and requires prior authorization and a doctor's referral. Over-the-counter (OTC) items are covered up to $25.00 per month, including nicotine replacement therapy, and a meal benefit is provided for chronic illnesses. However, several other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved