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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 2025, 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 2025.
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 $50.00. 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 $297.00 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier. For example, you will pay a $6 copay for Standard Generic drugs, $45 for Standard Generic drugs, and $90 for Preferred Brand drugs. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Imperial Senior Value (HMO C-SNP) plan offers a range of benefits, including inpatient hospital stays with no copay for the first 90 days, outpatient services with a $100 copay, and ambulance services with a copay or coinsurance. The plan also covers primary care, preventive services, hearing, vision, dental, and home health services. Additional benefits include coverage for prescription hearing aids, eyewear, and dental services, but with limitations on coverage amounts and specific services. There is also coverage for medical equipment, diagnostic and radiological services, skilled nursing facility services, and other services such as over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits with the Imperial Senior Value (HMO C-SNP) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-90, there is no copay, and for days 1-60, there is a $670 copay. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and ambulatory surgical center services, are covered with a $100 copay. Outpatient substance abuse services are also covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Imperial Senior Value (HMO C-SNP) plan and requires prior authorization and a doctor referral. You will be responsible for a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $150 copay and air ambulance services with 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for 100 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered under the Imperial Senior Value (HMO C-SNP) plan. Emergency Services have a $125 copay, with no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Imperial Senior Value (HMO C-SNP) plan covers primary care physician services, occupational therapy services with no copay and no coinsurance, and physical therapy and speech-language pathology services with no copay and no coinsurance. Chiropractic services, physician specialist services, other health care professional, opioid treatment program services, and additional telehealth benefits are covered, but require prior authorization and a referral. Mental health specialty services are covered with 20% coinsurance for individual and group sessions. Podiatry services are covered with 6 visits per year. Routine Chiropractic Care, and Individual and Group Sessions for Psychiatric Services are not covered.
Preventive Services See details
The Imperial Senior Value (HMO C-SNP) plan covers preventive services, including Medicare-covered services with no copay, as well as in-home support services and fitness benefits. The plan does not cover annual physical exams, health education, 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, support for caregivers, additional smoking cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, or counseling services.
Hearing Services See details
Hearing services with the Imperial Senior Value (HMO C-SNP) plan include hearing exams with a maximum benefit of $250 every year, and routine hearing exams and fitting/evaluation for hearing aids, each covered for 1 visit per year. Prescription hearing aids are covered, with a maximum benefit of $500 every year, but only the "all types" are covered, with "Inner Ear", "Outer Ear", and "Over the Ear" prescription hearing aids not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with one visit covered every year. Eyewear is covered, with a combined maximum benefit of $500 per year, and also includes one pair of contact lenses and eyeglasses annually. Eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
The Imperial Senior Value (HMO C-SNP) plan covers dental services with a $500 annual maximum benefit. This includes oral exams, dental x-rays, cleaning, fluoride treatments, restorative services, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery, with various limitations on the number of visits and periodicity. Orthodontic services are covered up to $3,000 annually, but the plan does not cover adjunctive general services, maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Coinsurance applies to the covered services, with a maximum coinsurance of 20% for both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Imperial Senior Value (HMO C-SNP) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices also have a 20% coinsurance; Durable Medical Equipment for use outside the home, 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 the Imperial Senior Value (HMO C-SNP) plan, though diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-Ray services are not covered. Therapeutic Radiological Services have a coinsurance of at most 20%, and there is no copay for these services.
Home Health Services See details
Home Health Services are covered by the Imperial Senior Value (HMO C-SNP) plan with a $10 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 Imperial Senior Value (HMO C-SNP) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Imperial Senior Value (HMO C-SNP) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, a $100 copay for days 21-50, and a $200 copay for days 51-100.
Other Services See details
The "Other Services" benefit for Imperial Senior Value (HMO C-SNP) covers over-the-counter items and a meal benefit, but does not cover acupuncture. Over-the-counter items are covered up to $130 every three months, and the meal benefit is covered up to $105 every year with prior authorization required. Many other services are not covered.
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