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Imperial Courage Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Imperial Courage Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Imperial Courage Plan (HMO) in 2025, please refer to our full plan details page.
Imperial Courage 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 Courage Plan (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Imperial Courage 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 Courage 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 $75.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Imperial Courage Plan (HMO).
Additional Benefits
The Imperial Courage Plan (HMO) offers a range of benefits, including inpatient hospital stays with a copay of $150 for days 1-5 and no copay for days 6-90, outpatient services with varying copays and coinsurance, and emergency services with a $125 copay. The plan also covers primary care, preventive services with no copay, hearing, vision, and dental services with annual maximums. Additional benefits include coverage for ambulance services, home health services, and skilled nursing facility stays with specific copays. The plan also provides coverage for home infusion bundled services, dialysis, medical equipment, and diagnostic services with different cost-sharing structures. The plan offers some additional benefits such as over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $150 copay for days 1-5, and a $0 copay for days 6-90; however, additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services, observation services, and ambulatory surgical center services have a $200 copay, and outpatient substance abuse services have a 20% coinsurance for 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's referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a $150 copay, while air ambulance services have a 20% coinsurance. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Imperial Courage Plan (HMO), with a $125 copay and no coinsurance. Urgently Needed Services have no copay or coinsurance, while Worldwide Urgent Coverage has a $20 copay and no coinsurance. Worldwide Emergency Transportation is not covered. Worldwide Emergency Services are covered, with a maximum plan benefit coverage of $50,000.
Primary Care See details
The Imperial Courage Plan (HMO) covers primary care physician services, occupational therapy services with a $10 copay, physician specialist services with a $5 copay, mental health specialty services with 20% coinsurance for individual and group sessions, podiatry services with a $5 copay for routine foot care (6 visits per year), other health care professional services with a $5 copay, physical therapy and speech-language pathology services with 20% coinsurance, additional telehealth benefits, and opioid treatment program services. Chiropractic services are partially covered, but routine chiropractic care is not covered, and psychiatric services are partially covered, but individual and group sessions are not covered.
Preventive Services See details
The Imperial Courage Plan (HMO) covers Medicare-covered preventive services with no copay, and also covers additional preventive services that are not usually covered by Medicare. Fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are also covered. However, 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 related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, 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, or counseling services.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a maximum benefit of $250 per year, and routine hearing exams and fitting/evaluation for hearing aids each cover one visit per year. Prescription Hearing Aids (all types) have a maximum benefit of $500 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $250 per year, and contact lenses and eyeglasses (lenses and frames) are covered once per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Imperial Courage Plan (HMO) offers dental services with a maximum plan benefit coverage of $500 per year, including coverage for oral exams, dental x-rays, cleaning, fluoride treatment, restorative services, prosthodontics (removable and fixed), and oral/maxillofacial surgery. Orthodontic services are covered with a maximum benefit of $1500 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 and require prior authorization. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Imperial Courage Plan (HMO), but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, with no copay and 20% coinsurance for Durable Medical Equipment (DME) and Prosthetic Devices, and some coverage for Prosthetics/Medical Supplies, which also has no copay and requires 20% coinsurance. The plan does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Imperial Courage Plan (HMO). Diagnostic Procedures/Tests and Lab Services have no copay and no coinsurance. Therapeutic Radiological Services have no copay and a coinsurance of at most 20%, while Diagnostic Radiological Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered under the Imperial Courage 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 not covered by the Imperial Courage Plan (HMO). Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $200.
Other Services See details
The Imperial Courage Plan (HMO) covers Over-the-Counter (OTC) Items with a maximum benefit of $75.00 every three months, and a Meal Benefit with a maximum benefit of $105.00 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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