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UCLA Health Medicare Advantage Prestige Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UCLA Health Medicare Advantage Prestige Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UCLA Health Medicare Advantage Prestige Plan (HMO) in 2026, please refer to our full plan details page.
UCLA Health Medicare Advantage Prestige Plan (HMO) is a HMO plan offered by The Regents of the University of California available for enrollment in 2025 to people living in Los Angeles County. The overall rating for this plan is not yet available for 2026.
It's important to know that UCLA Health Medicare Advantage Prestige Plan (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 UCLA Health Medicare Advantage Prestige Plan (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 UCLA Health Medicare Advantage Prestige Plan (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.00. 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 $250.00 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 $1499.00 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 UCLA Health Medicare Advantage Prestige Plan (HMO) offers an Enhanced Alternative prescription drug benefit with an annual drug deductible of $250.00. The standard Part D premium for this plan is $45.00, which is reduced to $33.00 for individuals qualifying for the low-income subsidy. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail services. For other prescription tiers during the initial coverage phase, you will pay a $47.00 copay for Tier 2 standard generics, 45% coinsurance for Tier 3 preferred brands, and 30% coinsurance for Tier 4 non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UCLA Health Medicare Advantage Prestige Plan (HMO) offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, annual physical exams, and Medicare-covered preventive services. For outpatient care, members can expect affordable options, such as a $15 copay for urgent care and mental health services, and a $75 copay for emergency room visits with no coinsurance. Additionally, the plan features no copay for the first 20 days of a skilled nursing facility stay, followed by a $75 daily copay up to day 100. Specialty benefits include vision care with no deductible and a $250 annual eyewear allowance, alongside hearing coverage featuring routine exams with no copay and prescription hearing aid copays ranging from $195 to $1,395. Dental services are also available with no coinsurance and copays ranging from no copay up to $656 depending on the procedure. Members also benefit from a $100 quarterly over-the-counter allowance, up to 24 one-way transit trips per year with no copay, and covered home health services.
Inpatient Hospital See details
UCLA Health Medicare Advantage Prestige Plan (HMO) partially covers inpatient hospital services, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization and doctor referrals are required, and sub-services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by the UCLA Health Medicare Advantage Prestige Plan (HMO), including outpatient hospital, observation, ambulatory surgical center, and blood services, which require prior authorization and doctor referrals. Outpatient substance abuse individual and group sessions are covered with a $15 copay and no coinsurance.
Partial Hospitalization See details
UCLA Health Medicare Advantage Prestige Plan (HMO) covers partial hospitalization services with a $50 copay and no coinsurance. These covered benefits require prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the UCLA Health Medicare Advantage Prestige Plan (HMO), featuring a $100 copay and no coinsurance for ground ambulance, and a 20% coinsurance with no copay for air ambulance. Transportation is partially covered, providing up to 24 one-way trips per year to plan-approved locations via bus or subway with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
UCLA Health Medicare Advantage Prestige Plan (HMO) covers emergency services with a $75 copay and no coinsurance, and urgently needed services with a $15 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with copays ranging from $15 to $100 and no coinsurance, up to a $50,000 maximum benefit limit.
Primary Care See details
Primary Care benefits are partially covered under the UCLA Health Medicare Advantage Prestige Plan (HMO), with podiatry services not covered. Covered services like mental health, psychiatric, and opioid treatment sessions require a $15 copay and no coinsurance, while other services like chiropractic care are limited to 12 routine visits per year with no coinsurance.
Preventive Services See details
Preventive services are covered under the UCLA Health Medicare Advantage Prestige Plan (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services, annual physical exams, and kidney disease education. However, additional preventive benefits are only partially covered, excluding health education, 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, home-based palliative care, caregiver support, additional smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by the UCLA Health Medicare Advantage Prestige Plan (HMO), which offers annual routine exams and fitting evaluations with no deductible. Prescription hearing aids (all types) are covered up to two per year with a copay ranging from $195 to $1,395 and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the UCLA Health Medicare Advantage Prestige Plan (HMO) with no deductible and a $250 annual eyewear allowance, though specific copay and coinsurance amounts are not listed. This benefit includes one annual routine eye exam, contact lenses, and complete eyeglasses, but does not cover individual eyeglass lenses, eyeglass frames, or upgrades.
Dental Services See details
UCLA Health Medicare Advantage Prestige Plan (HMO) offers partially covered dental services, as maxillofacial prosthetics, implant services, and orthodontics are not covered. Covered dental benefits require no coinsurance, with copays ranging from no copay up to $656 depending on the service.
Home Infusion bundled Services See details
UCLA Health Medicare Advantage Prestige Plan (HMO) covers home infusion bundled services with no copay and coinsurance ranging from no coinsurance to 20% for Part B chemotherapy, radiation, and other Part B drugs. Prior authorization is required for these benefits, which also cover Medicare Part B insulin drugs and may require step therapy.
Dialysis Services See details
Dialysis services are covered by the UCLA Health Medicare Advantage Prestige Plan (HMO) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Medical Equipment See details
Medical Equipment is partially covered by the UCLA Health Medicare Advantage Prestige Plan (HMO) with no copays, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment requires 20% to 50% coinsurance, medical supplies require 20% coinsurance, and prosthetic devices and diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by the UCLA Health Medicare Advantage Prestige Plan (HMO), with diagnostic procedures, lab services, and outpatient X-ray services not covered. Covered diagnostic radiological services require no coinsurance and a copay of up to $50, with no copay at the minimum, while therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered under the UCLA Health Medicare Advantage Prestige Plan (HMO). To access these benefits, members must obtain prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
UCLA Health Medicare Advantage Prestige Plan (HMO) notes that some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by the UCLA Health Medicare Advantage Prestige Plan (HMO), requiring prior authorization and a doctor referral. Covered stays feature no copay for days 1 to 20 and a $75 daily copay for days 21 to 100, with no coinsurance, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the UCLA Health Medicare Advantage Prestige Plan (HMO), including up to 12 acupuncture treatments per year, chronic illness meal benefits with a doctor's referral, and a $100 quarterly over-the-counter allowance. Highly integrated dual eligible SNP services, nicotine replacement therapy, and naloxone are not covered.
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