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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 2025, 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 2.5 out of 5 stars in 2025.
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:
Sign up for Central Health Medicare Plan (HMO)
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Drug Coverage
The Central Health Medicare Plan (HMO) has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, preferred generic drugs and specialty tier drugs have no copay. For standard generic drugs, the copay is $35.00, and for preferred brand drugs, the copay is $75.00. Non-preferred drugs have a 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Central Health Medicare Plan (HMO) offers a range of benefits with varying cost-sharing. Many services have no copay, including primary care, preventive services, hearing exams, vision exams, and many dental services. Emergency services and outpatient services have copays, and services like dialysis and therapeutic radiological services have coinsurance costs. The plan also includes coverage for ambulance services, home health, and medical equipment. Additionally, there are benefits for home infusion, diagnostic services, and skilled nursing facilities. However, it's important to note that some services, such as certain dental, vision, and hearing services, have limitations or maximum benefit amounts.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Central Health Medicare Plan (HMO). Inpatient Hospital-Acute has no copay, but additional days, non-Medicare-covered stays, and upgrades are not covered. Inpatient Hospital Psychiatric has a $175 copay for days 1-7, and no copay for days 8-90, with additional days and non-Medicare-covered stays not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, have a copay between $0 and $100, while Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services, including individual and group sessions, have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Central Health Medicare Plan (HMO), but requires prior authorization and a doctor referral. You will have a $10 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance. Ground ambulance services have a copay between $0 and $200, while air ambulance services have a $200 copay. Transportation Services to a plan-approved health-related location are covered with a $0 copay for up to 12 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Central Health Medicare Plan (HMO). Emergency Services have a copay between $0 and $140 and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay and no coinsurance.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Chiropractic Services, Occupational Therapy Services, Other Health Care Professional, and Opioid Treatment Program Services have no copay. Mental Health Specialty Services and Psychiatric Services have a $40 copay for individual and group sessions. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, with no copay, and additional preventive services, including Health Education, In-Home Safety Assessment, Personal Emergency Response System, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Fitness Benefit, all with no copay. Annual physical exams, 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, Counseling Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
The Central Health Medicare Plan (HMO) covers hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and OTC hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $2,000 per year, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with no copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, all with no copay. Eyewear has a combined maximum benefit of $300 per year.
Dental Services See details
The Central Health Medicare Plan (HMO) offers dental services including oral exams with a copay of $0-$17, dental x-rays with a copay of $0-$41, other diagnostic dental services with a copay of $0-$15, prophylaxis (cleaning) with no copay, fluoride treatment with a copay of $0-$13, and other preventive dental services with no copay. Restorative services have a copay of $0-$424, adjunctive general services have a copay of $0-$166, endodontics and periodontics have no copay, removable prosthodontics has a copay of $0-$220, implant services have a copay of $0-$2160, fixed prosthodontics has a copay of $75-$295, and oral and maxillofacial surgery has a copay of $0-$237; however, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Central Health Medicare 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 is covered, including durable medical equipment (DME) with no copay and 0-20% coinsurance, prosthetics and medical supplies with no copay and 20% coinsurance, and diabetic equipment with no copay for diabetic supplies and diabetic therapeutic shoes/inserts. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Central Health Medicare Plan (HMO). Diagnostic Procedures/Tests and Lab Services have no copay, while Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Central Health Medicare Plan (HMO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. This plan does not cover additional days beyond Medicare-covered for SNF, nor does it cover non-Medicare-covered stays.
Other Services See details
Other Services includes acupuncture with no copay, and over-the-counter items with no copay. The meal benefit has a copay between $0 and $5. However, 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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