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Imperial Dual Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Imperial Dual Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Imperial Dual Plan (HMO D-SNP) in 2025, please refer to our full plan details page.
Imperial Dual Plan (HMO D-SNP) is a HMO D-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 Dual Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Imperial Dual Plan (HMO D-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 Dual Plan (HMO D-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 Dual Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.70. 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 $590.00 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 $2999.00 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 Dual Plan (HMO D-SNP) has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, you will pay 25% coinsurance for standard generic, preferred brand, and non-preferred drugs. If you qualify for the low-income subsidy (LIS), you will pay $29.70. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Imperial Dual Plan (HMO D-SNP) offers a variety of benefits to help cover your healthcare needs. Many services, such as primary care, outpatient services, and vision services, have a 20% coinsurance. The plan also provides coverage for hearing exams and prescription hearing aids, offering up to $2500 per year. Additionally, this plan includes no-copay coverage for transportation services to health-related locations (up to 100 one-way trips per year), diagnostic and radiological services, and home health services. Dental services are available with a $500 annual maximum for other dental services and a $1,500 annual maximum for orthodontics. Also included is an over-the-counter (OTC) allowance of $140 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but the plan does not cover additional days for inpatient hospital, non-Medicare-covered stays, or upgrades for acute care, and also does not cover additional days or non-Medicare-covered stays for psychiatric care. The copay for these services is based on the Medicare-defined cost share for tier 1.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, both with a 20% coinsurance, as well as Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, which have a coinsurance of 20%. 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 by the Imperial Dual Plan (HMO D-SNP). Ground and Air Ambulance Services have a 20% coinsurance, and the plan covers transportation services to plan-approved health-related locations, with a limit of 100 one-way trips per year, with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Imperial Dual Plan (HMO D-SNP), with a 20% coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Imperial Dual Plan (HMO D-SNP) covers primary care services with a 20% coinsurance, and also covers chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with a 20% coinsurance. Routine Chiropractic Care is limited to 12 visits per year.
Preventive Services See details
Preventive Services are covered, with some services requiring a doctor referral or prior authorization. Medicare-covered zero-dollar preventive services are covered with a doctor referral, while annual physical exams, health education, in-home safety assessments, 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 benefit, 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. The plan has a 20% coinsurance for kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
The Imperial Dual Plan (HMO D-SNP) covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, each with one visit per year; prescription hearing aids are covered up to a maximum of $2500 per year. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a 20% coinsurance, and for eyewear, with a combined maximum benefit of $500 per 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 include coverage for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with a $500 annual maximum for other dental services and a $1,500 annual maximum for orthodontics; however, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan covers one intraoral exam every 12 months, one dental x-ray every six months, one prophylaxis (cleaning) every six months, one fluoride treatment every six months, one endodontic service per lifetime, and one periodontal service every 24 months.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Imperial Dual Plan (HMO D-SNP). Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Imperial Dual Plan (HMO D-SNP), but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance, and requires prior authorization. Prosthetic Devices and Diabetic Supplies have a 20% coinsurance, while Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Imperial Dual Plan (HMO D-SNP) with no copay. For Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Imperial Dual Plan (HMO D-SNP) with no copay and no coinsurance, but require both authorization and a referral. 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 Dual Plan (HMO D-SNP). 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 Dual Plan (HMO D-SNP) and require prior authorization and a doctor referral, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. The plan charges the Medicare-defined cost share for tier 1, and more information about the copay can be found in the plan details.
Other Services See details
The Imperial Dual Plan (HMO D-SNP) covers Over-the-Counter (OTC) items with a maximum benefit of $140 every three months, and a meal benefit for chronic illnesses with a maximum benefit of $105 per year, requiring prior authorization. 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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