A non-government entity
Central Health Medicare Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Medicare Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Central Health Medicare Plan (HMO) in 2026, please refer to our full plan details page.
Central Health Medicare Plan (HMO) is a HMO plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Counties: LA, SBD, RS, OC. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Central Health Medicare 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 Central Health Medicare 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 Central Health Medicare 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.
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 $1100.00 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 Central Health Medicare Plan (HMO) features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs and Tier 5 specialty tier drugs filled at standard pharmacies or via standard mail. For other tiers, you will pay a $35 copay for Tier 2 standard generics, a $75 copay for Tier 3 preferred brands, and a 33% coinsurance for Tier 4 non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy can see their Part D premium reduced to $0.
Additional Benefits
The Central Health Medicare Plan (HMO) offers robust coverage with many services featuring no copay and no coinsurance, including primary care, specialist visits, physical therapy, and acute inpatient hospital stays. For emergency care, members pay a $150 copay with no coinsurance, which is waived if hospitalized, while urgently needed services require no copay. Outpatient hospital services and surgeries generally have low to no copays and no coinsurance, making essential medical care highly affordable. Routine vision, hearing, and preventive services are covered with no copay or coinsurance, including annual eye exams and over-the-counter hearing aids. Dental benefits feature no coinsurance, with copays ranging from no copay up to $2,160 depending on the procedure. Additionally, members benefit from no copays on home health services, diabetic supplies, and diagnostic lab tests, though some specialized services like dialysis and durable medical equipment require coinsurance up to 20 percent.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Central Health Medicare Plan (HMO), as upgrades, additional days, and non-Medicare-covered stays are not covered. Acute stays feature no copay and no coinsurance, while psychiatric stays require a $175 daily copay for days 1-7 and no copay or coinsurance for days 8-90. Both options require prior authorization and a doctor referral.
Outpatient Services See details
Central Health Medicare Plan (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center, outpatient blood, and substance abuse services with no copay. Outpatient hospital services require a copay of $0 to $100, and observation services require a $100 copay per stay.
Partial Hospitalization See details
Central Health Medicare Plan (HMO) covers partial hospitalization benefits with a $10.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Central Health Medicare Plan (HMO) with no coinsurance, featuring a $0 to $200 copay for ground ambulance and a $200 copay for air ambulance. Transportation benefits are partially covered with no copay or coinsurance for up to 12 yearly one-way trips to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Central Health Medicare Plan (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within three days. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 limit with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by the Central Health Medicare Plan (HMO), offering no copay or coinsurance for PCP, specialist, physical therapy, and occupational therapy visits. Mental health and psychiatric services require a $40 copay and no coinsurance, while podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by the Central Health Medicare Plan (HMO) with no copays or coinsurance for covered benefits. However, annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered under the Central Health Medicare Plan (HMO) with no copay or coinsurance for routine hearing exams, fitting evaluations, and over-the-counter hearing aids. Prescription hearing aids are partially covered, offering up to two devices every two years, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Central Health Medicare Plan (HMO) covers vision services, including one routine eye exam per year and eyewear, with no copay or coinsurance. There is an annual combined maximum benefit of $200 for eyewear, and services require prior authorization and a doctor referral.
Dental Services See details
Dental Services are partially covered by Central Health Medicare Plan (HMO), featuring no coinsurance and copays ranging from no copay up to $2,160.00 depending on the procedure. While preventive and comprehensive options like exams, cleanings, and implants are covered, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Central Health Medicare Plan (HMO) with prior authorization required. Covered Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy, radiation, and other Part B drugs require no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Central Health Medicare Plan (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by the Central Health Medicare Plan (HMO), with prior authorization required for all services. Diabetic supplies and therapeutic shoes feature no copay and no coinsurance, durable medical equipment (DME) has no copay and 0% to 20% coinsurance, and prosthetic devices and medical supplies require no copay and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Central Health Medicare Plan (HMO), requiring prior authorization and doctor referrals. Members pay no copay and no coinsurance for diagnostic tests, lab services, diagnostic radiology, and outpatient X-rays, while therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Home Health Services are covered by the Central Health Medicare Plan (HMO) with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Central Health Medicare Plan (HMO), meaning there is no coverage or cost-sharing benefits for cardiac, intensive cardiac, pulmonary, or supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Central Health Medicare Plan (HMO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the Medicare-covered limit are not covered. Covered services require prior authorization and a doctor referral, and they are subject to Medicare-defined coinsurance with no copay.
Other Services See details
Central Health Medicare Plan (HMO) offers partially covered Other Services, which include acupuncture and over-the-counter items with no copay and no coinsurance, as well as meal benefits. Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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