A non-government entity
Central Health Ventura Medicare Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Ventura 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 Ventura Medicare Plan (HMO) in 2025, please refer to our full plan details page.
Central Health Ventura Medicare Plan (HMO) is a HMO plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Ventura County. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Central Health Ventura 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 Ventura 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 Ventura 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 $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:
Sign up for Central Health Ventura Medicare Plan (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Central Health Ventura Medicare Plan (HMO) has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay at standard and mail pharmacies, while standard generic drugs have a $47 copay. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs.
Additional Benefits
The Central Health Ventura Medicare Plan (HMO) offers a range of benefits with varying costs. Hospital stays have copays, while outpatient services, including many diagnostic tests and lab services, often have no copay. Emergency, primary care, and preventive services are covered with no copay. The plan also includes coverage for vision, dental, hearing, and home health services, with some services having no copay. There is also coverage for ambulance and transportation services, with some services having no copay. However, it's important to note that certain services like cardiac rehabilitation and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor referral. For Inpatient Hospital-Acute, you will pay a $225 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $175, and Observation Services with a copay between $0 and $175. Additionally, Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Central Health Ventura Medicare Plan (HMO), with a $0 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a copay between $0 and $225, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year. 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. Emergency Services have a copay between $0 and $125, and no coinsurance; Urgently Needed Services have no copay and no coinsurance; and Worldwide Emergency Services have a $125 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with a maximum plan benefit of $50,000.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with no copay, Occupational Therapy Services with a $10 copay, Physician Specialist Services with a $10 copay, Mental Health Specialty Services (Individual Sessions with a $30 copay, Group Sessions with a $30 copay), Other Health Care Professional services with a copay between $0 and $10, Psychiatric Services (Individual Sessions with a $30 copay, Group Sessions with a $30 copay), Physical Therapy and Speech-Language Pathology Services with a $10 copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $30 copay. Chiropractic services require prior authorization and a doctor referral, and routine chiropractic care is not covered. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, but annual physical exams and telemonitoring services are not. Medicare-covered preventive services, Health Education, Personal Emergency Response System (PERS), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, Fitness Benefit, Enhanced Disease Management, and Remote Access Technologies have no copay. Other services such as In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Counseling Services are not covered.
Hearing Services See details
Hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and OTC hearing aids are covered with no copay. Prescription Hearing Aids (all types) are covered. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Central Health Ventura Medicare Plan (HMO) offers vision services, including eye exams and eyewear. Eye exams and routine eye exams have no copay, and eyewear has no copay; however, contact lenses are subject to a copay. Eyewear has a combined maximum benefit of $300 per year, and eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each limited to one per year.
Dental Services See details
Dental Services include coverage for 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, other preventive dental services with no copay, restorative services with a copay of $0-$424, adjunctive general services with a copay of $0-$166, endodontics and periodontics with no copay, prosthodontics (removable) with a copay of $0-$220, implant services with a copay of $0-$2160, prosthodontics (fixed) with a copay of $75-$295, and oral and maxillofacial surgery with a copay of $0-$237. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor's referral. The coinsurance for this service is 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with no copay and a 20% coinsurance; Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment has no copay, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of at most 20% (minimum of 0%), Therapeutic Radiological Services have a coinsurance of at most 20% (minimum of 20%), and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Central Health Ventura 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 not covered by the Central Health Ventura Medicare Plan (HMO). 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) benefits are covered by the Central Health Ventura Medicare Plan (HMO), but require prior authorization and a doctor's referral. The plan follows Original Medicare guidelines for SNF cost sharing, and does not cover additional days beyond Medicare-covered, nor does it cover non-Medicare-covered stays.
Other Services See details
The Central Health Ventura Medicare Plan (HMO) covers acupuncture with no copay, and over-the-counter (OTC) items with no copay. The plan also covers a meal benefit with a copay between $0 and $5. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved