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Imperial Senior Value (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Imperial Senior Value (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Imperial Senior Value (HMO C-SNP) in 2026, please refer to our full plan details page.
Imperial Senior Value (HMO C-SNP) is a HMO C-SNP plan offered by Imperial Health Plan of California available for enrollment in 2025 to people living in Northern, Central and Southern California. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Imperial Senior Value (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Imperial Senior Value (HMO C-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 Imperial Senior Value (HMO C-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 Imperial Senior Value (HMO C-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. Additionally, this plan comes with a Part B Premium reduction of $25.00. You must continue to pay paying your reduced 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 $296.00 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 Imperial Senior Value (HMO C-SNP) plan offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, standard pharmacy copays are $6 for preferred generics, $45 for standard generics, $90 for preferred brands, and $3 for specialty tier drugs. Non-preferred drugs require a 33% coinsurance until your total drug costs reach $2,100. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Additionally, individuals who qualify for the full low-income subsidy will pay nothing for their Part D premium. Please check the plan's formulary to confirm coverage for your specific medications.
Additional Benefits
The Imperial Senior Value (HMO C-SNP) plan offers robust medical coverage, featuring inpatient hospital stays for up to 90 days and Medicare-covered preventive services with no copay. Outpatient hospital services require a $100 copay, while emergency room visits have a $125 copay that is waived upon admission. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by daily copays for subsequent days. Additionally, the plan provides key supplemental benefits, including up to 100 one-way transportation trips, a $130 quarterly over-the-counter allowance, and up to $3,000 for comprehensive dental care. Vision and hearing services are covered with no deductibles, featuring routine exams alongside allowances for eyewear and hearing aids. For specialized needs like dialysis and durable medical equipment, members pay a 20% coinsurance with no copay.
Inpatient Hospital See details
Imperial Senior Value (HMO C-SNP) covers inpatient acute and psychiatric hospital stays for days 1 through 90 with no copay and no coinsurance, though prior authorization and a doctor referral are required. These benefits are partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Imperial Senior Value (HMO C-SNP) covers outpatient hospital, observation, and ambulatory surgical center services with a $100 copay and no coinsurance. Outpatient substance abuse services are covered with a 20% coinsurance and no copay, while outpatient blood services are covered with no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Imperial Senior Value (HMO C-SNP) with no copay and a 20% coinsurance. These services require prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Imperial Senior Value (HMO C-SNP) covers ground ambulance services with a $150 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, allowing up to 100 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Imperial Senior Value (HMO C-SNP) with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services require no copay or coinsurance, and worldwide emergency services are partially covered up to a $100,000 limit, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits are partially covered by Imperial Senior Value (HMO C-SNP), including doctor visits, physical therapy, podiatry, and chiropractic care, though copay and coinsurance details are not specified. Most covered services require prior authorization and a doctor referral, while mental health specialty and psychiatric services are not covered in practice.
Preventive Services See details
Preventive services are covered by Imperial Senior Value (HMO C-SNP) with no copay or coinsurance for Medicare-covered preventive benefits, fitness programs, and in-home support. However, some services are not covered under this plan, including annual physical exams, health education, and weight management programs.
Hearing Services See details
Hearing services are partially covered by Imperial Senior Value (HMO C-SNP) with no deductible, though copayment and coinsurance details are not specified. The plan covers annual routine exams and fitting evaluations up to $250, and general prescription hearing aids up to $500, but 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 Imperial Senior Value (HMO C-SNP) with no deductible, featuring one routine eye exam and a $500 annual maximum limit for eyewear. Copay and coinsurance details are not specified, and eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Imperial Senior Value (HMO C-SNP) partially covers dental services, offering up to a $500 annual maximum for basic care and a $3,000 annual maximum for comprehensive treatments. While services like cleanings, exams, and restorative care are covered, the plan does not cover adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Imperial Senior Value (HMO C-SNP) with prior authorization, requiring no copay and coinsurance ranging from no coinsurance up to 20% for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are also covered under this benefit.
Dialysis Services See details
Dialysis Services are covered by Imperial Senior Value (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Imperial Senior Value (HMO C-SNP) partially covers medical equipment, offering durable medical equipment and prosthetic devices with no copay and a 20% coinsurance, subject to prior authorization. However, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Imperial Senior Value (HMO C-SNP) with no copays, though diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-ray services are not covered. Covered therapeutic radiological services require a 20% coinsurance and no copay, and prior authorization and doctor referrals are required.
Home Health Services See details
Home Health Services are covered under the Imperial Senior Value (HMO C-SNP) plan, though prior authorization and a doctor referral are required to receive care. No copay or coinsurance details are specified for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Imperial Senior Value (HMO C-SNP) plan, meaning there is no coverage, copay, or coinsurance for cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Imperial Senior Value (HMO C-SNP), featuring no coinsurance and no copay for days 1-20, followed by a $100 daily copay for days 21-50 and a $200 daily copay for days 51-100. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Imperial Senior Value (HMO C-SNP) partially covers Other Services, offering up to 35 acupuncture treatments per year, a $130 quarterly over-the-counter reimbursement allowance, and a $105 annual chronic illness meal benefit with prior authorization. Dual Eligible SNPs with Highly Integrated Services and nicotine replacement therapy are not covered under these benefits.
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