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Imperial Dynamic Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Imperial Dynamic Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Imperial Dynamic Plan (HMO) in 2025, please refer to our full plan details page.
Imperial Dynamic Plan (HMO) is a HMO plan offered by Imperial Health Plan of California available for enrollment in 2025 to people living in Northern, Central, Southern California. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Imperial Dynamic 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 Imperial Dynamic 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 Imperial Dynamic Plan (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. Additionally, this plan comes with a Part B Premium reduction of $60.00. 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 Dynamic Plan (HMO) 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'll pay a $6 copay for a preferred generic drug at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Medicare Part D covered drugs. Please note that this plan may have reduced premiums if you qualify for the low-income subsidy.
Additional Benefits
The Imperial Dynamic Plan (HMO) offers a range of benefits with varying costs. Inpatient hospital stays have no copay for the first 90 days, and outpatient services have a $100 copay. Emergency services have a $125 copay, while other services, like primary care, vision, and home health, have no copay. This plan also includes coverage for hearing, vision, and dental services, with limits on hearing aids and eyewear. Additional benefits include ambulance and transportation services, partial hospitalization, and medical equipment. The plan may have coinsurance for some services, such as outpatient substance abuse and dialysis.
Inpatient Hospital See details
Inpatient Hospital services, including both Acute and Psychiatric, are covered with a doctor referral and prior authorization. For days 1-90, there is no copay, and for days 1-60, there is a $670 copay.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and ambulatory surgical center services, are covered by the Imperial Dynamic Plan (HMO). Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services each have a $100 copay. Outpatient Substance Abuse Services are covered with 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 by the Imperial Dynamic Plan (HMO). 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 100 one-way trips per year, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Imperial Dynamic Plan (HMO). Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Services are covered up to $100,000, with no copay or coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Imperial Dynamic Plan (HMO) covers primary care physician 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. Individual and group sessions for mental health specialty services have a 20% coinsurance. Occupational therapy services, and physical therapy and speech-language pathology services have no copay and no coinsurance. Routine chiropractic care, and individual and group sessions for psychiatric services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, are covered, while annual physical exams are not. Additional preventive services have limited coverage, with services like health education and counseling services not covered, while In-Home Support Services and Fitness Benefits are covered. Glaucoma screenings, diabetes self-management training, and barium enemas require prior authorization.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids, each covered once per year. Hearing exams have a maximum benefit of $250 per year, while prescription hearing aids have a maximum benefit of $500 per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Imperial Dynamic Plan (HMO) covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum benefit of $500 per year. Contact lenses and eyeglasses (lenses and frames) are covered, with a limit of one pair per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Imperial Dynamic Plan (HMO) covers dental services with a $500 annual maximum, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Orthodontic services are covered up to $4,000 per year, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered. Endodontics and periodontics are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Imperial Dynamic Plan (HMO). Coinsurance may apply for these services, ranging from 0% to 20% depending on the specific drug.
Dialysis Services See details
Dialysis Services are covered by the Imperial Dynamic Plan (HMO) and require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) subject to a 20% coinsurance and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit and Prosthetic Devices are covered, with a 20% coinsurance for Prosthetic Devices, and no copay. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services has a coinsurance of at most 20%, while all other covered services have no copay.
Home Health Services See details
Home Health Services are covered under the Imperial Dynamic Plan (HMO) 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 technically covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Imperial Dynamic Plan (HMO) with prior authorization and a doctor referral required. There is no copay for days 1-20, a $100 copay for days 21-50, and a $200 copay for days 51-100, and additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $140 every three months, and a Meal Benefit with a maximum benefit of $105 per year that requires 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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