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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 2025, 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 2025.
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 $39.00. 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 $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) has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, standard generic drugs have a $47 copay, while preferred brand drugs have a 45% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, if you qualify for the low-income subsidy, your monthly Part D premium will be reduced to $9.30.
Additional Benefits
The UCLA Health Medicare Advantage Prestige Plan (HMO) offers comprehensive coverage with no copay for inpatient hospital stays, primary care, home health, and preventive services like routine eye exams. The plan also includes coverage for outpatient services, ambulance services, emergency services, hearing and vision services, dental services, home infusion, dialysis, and medical equipment with various copays, coinsurance, and annual limits. The plan provides extra benefits like transportation services, over-the-counter items, and acupuncture, while also covering skilled nursing facility stays with a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has no copay for a Medicare-covered stay, and additional days for Inpatient Hospital-Acute has no copay for days 91-999, while non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric has no copay for a Medicare-covered stay, and additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Individual and group sessions for outpatient substance abuse have a copay of $15.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the UCLA Health Medicare Advantage Prestige Plan (HMO) with a $50 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. 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, offering up to 24 one-way trips per year via bus/subway, however, transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the UCLA Health Medicare Advantage Prestige Plan (HMO), with a $75 copay for emergency services, no coinsurance, and a $15 copay for urgently needed services with no coinsurance. Worldwide emergency services are also covered, with a $75 copay for Worldwide Emergency Coverage, a $15 copay for Worldwide Urgent Coverage, and a $100 copay for Worldwide Emergency Transportation, with a maximum plan benefit coverage of $50,000.
Primary Care See details
The UCLA Health Medicare Advantage Prestige Plan (HMO) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group mental health and psychiatric sessions have a $15 copay, while occupational therapy, physical therapy, and speech-language pathology services have no copay or coinsurance. Podiatry services are not covered.
Preventive Services See details
The UCLA Health Medicare Advantage Prestige Plan (HMO) covers a variety of preventive services, including annual physical exams, in-home safety assessments, personal emergency response systems, nutritional/dietary benefits, in-home support services, support for caregivers, fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Health education, medical nutrition therapy, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, counseling services, and additional sessions of smoking and tobacco cessation counseling are not covered.
Hearing Services See details
Hearing services through the UCLA Health Medicare Advantage Prestige Plan (HMO) include routine hearing exams and fitting/evaluation for hearing aids, both covered once per year, as well as prescription hearing aids, with a copay between $195 and $1395 for all types of prescription hearing aids. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear with a combined maximum plan benefit of $250 every year. Contact lenses and eyeglasses (lenses and frames) are also covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services with a copay of $7-$410, adjunctive general services with a copay of $0-$64, endodontics with a copay of $12-$154, periodontics with a copay of $0-$130, prosthodontics (removable) with a copay of $16-$656, prosthodontics (fixed) with a copay of $42-$412, and oral and maxillofacial surgery with a copay of $3-$152; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare Dental Services require prior authorization and a doctor referral.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the UCLA Health Medicare Advantage Prestige Plan (HMO), but require prior authorization and a doctor's referral. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20-50% coinsurance and Prosthetics/Medical Supplies with 0-20% coinsurance; Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of up to $50, and Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the UCLA Health Medicare Advantage Prestige Plan (HMO), 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 not covered by the UCLA Health Medicare Advantage Prestige Plan (HMO). 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 UCLA Health Medicare Advantage Prestige Plan (HMO), but require prior authorization and a doctor referral. There is no copay for days 1-20, and a $75 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The UCLA Health Medicare Advantage Prestige Plan (HMO) covers acupuncture, with a limit of 12 treatments per year. Over-the-counter items are covered, with a maximum benefit of $100 every three months. A meal benefit is also included, requiring prior authorization and a doctor's referral. Additionally, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and more are not covered.
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