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Imperial Traditional (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Imperial Traditional (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Imperial Traditional (HMO) in 2025, please refer to our full plan details page.
Imperial Traditional (HMO) is a HMO 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 Traditional (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 Imperial Traditional (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 Imperial Traditional (HMO), 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 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 Imperial Traditional (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, you will pay a $10 copay for preferred generic drugs at a standard pharmacy, and a $90 copay for preferred brand drugs at a standard pharmacy. Once your total drug costs reach $2,000, you will enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Imperial Traditional (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have no copay for most days, but a copay applies for days 4-5. Outpatient services, including hospital and ambulatory surgical center visits, have a copay, and substance abuse services have coinsurance. Emergency services have a copay, and primary care visits have a copay. This plan also covers preventive services with no copay, along with hearing, vision, and dental services with annual limits. Home health services have a copay, and skilled nursing facility stays have a copay that varies by the length of stay. The plan also covers ambulance and transportation services, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered by the Imperial Traditional (HMO) plan. For days 1-3 and days 6-90, there is no copay, and for days 4-5, there is a $150 copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services. Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services each have a $100 copay, while Outpatient Substance Abuse Services have a 20% coinsurance for both individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $150 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 100 one-way trips per year, utilizing rideshare services, bus/subway, van, or medical transport.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Imperial Traditional (HMO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Coverage has no copay and no coinsurance, while Worldwide Urgent Coverage has a $20 copay and no coinsurance. Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000.
Primary Care See details
The Imperial Traditional (HMO) plan covers primary care physician services, occupational therapy services with a $10 copay, and mental health specialty services with 20% coinsurance for individual and group sessions. Physical therapy and speech-language pathology services are covered with 20% coinsurance, and podiatry services are covered for up to 6 visits per year. Chiropractic services, psychiatric services (individual and group sessions) and routine chiropractic care are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay. However, 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 related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. In-Home Support Services and Fitness Benefits are covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered, but may require prior authorization or a doctor's referral.
Hearing Services See details
The Imperial Traditional (HMO) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with a yearly maximum benefit of $250 for hearing exams. Prescription hearing aids (all types) are covered with a maximum benefit of $500 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Imperial Traditional (HMO) plan covers vision services including routine eye exams with one visit per year, and eyewear with a combined maximum benefit of $500 every year. Contact lenses and eyeglasses (lenses and frames) are covered with one pair per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Imperial Traditional (HMO) plan covers dental services with a maximum benefit of $500 per year, including oral exams and dental x-rays, each with a limited number of visits. Prophylaxis (cleaning) and fluoride treatments are also covered, with a limited number of visits. Orthodontic services are covered with a maximum benefit of $3,000 per year, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%, and Medicare Part B Insulin Drugs are covered.
Dialysis Services See details
Dialysis Services are covered under the Imperial Traditional (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered, and coverage for Diabetic Equipment requires prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all services. Diagnostic Procedures/Tests and Lab Services have no coinsurance, while Therapeutic Radiological Services have a coinsurance of at most 20%. Diagnostic Radiological Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Imperial Traditional (HMO) 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 Traditional (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Imperial Traditional (HMO) plan, with a doctor referral and prior authorization required. You will have no copay for days 1-20, a $100 copay for days 21-50, and a $200 copay for days 51-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Imperial Traditional (HMO) plan's "Other Services" benefit covers Over-the-Counter (OTC) items with a maximum benefit coverage amount of $95 every three months, and a meal benefit for a chronic illness with a maximum benefit coverage amount of $105 every year. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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