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Central Health Medi-Medi Plan II (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Medi-Medi Plan II (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Central Health Medi-Medi Plan II (HMO D-SNP) in 2025, please refer to our full plan details page.
Central Health Medi-Medi Plan II (HMO D-SNP) is a HMO D-SNP 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 Medi-Medi Plan II (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Central Health Medi-Medi Plan II (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Central Health Medi-Medi Plan II (HMO D-SNP).
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 Medi-Medi Plan II (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.70. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 Medi-Medi Plan II (HMO D-SNP) has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). With LIS, you will pay $29.70 for Part D.
Additional Benefits
The Central Health Medi-Medi Plan II (HMO D-SNP) offers a range of benefits with varying cost-sharing. Many services have no copay, including preventive services, hearing exams, eye exams, and dental services. However, services like emergency services have a $110 copay, and outpatient services, ambulance services, and medical equipment have a 20% coinsurance. This plan provides coverage for inpatient and outpatient services, with some requiring prior authorization or a doctor's referral. The plan also includes coverage for transportation to health-related locations, with a limit of 24 one-way trips per year. Additionally, the plan covers prescription hearing aids, eyewear (up to a $300 combined maximum), and offers benefits such as acupuncture, OTC items, and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a required doctor referral and prior authorization. Additional days for acute and psychiatric care, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a coinsurance of 20%. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Central Health Medi-Medi Plan II (HMO D-SNP) and requires prior authorization and a doctor's referral. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Central Health Medi-Medi Plan II (HMO D-SNP). Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the Central Health Medi-Medi Plan II (HMO D-SNP) with a $110 copay, and no coinsurance. Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The Central Health Medi-Medi Plan II (HMO D-SNP) plan covers primary care services with 28% coinsurance. Chiropractic services are covered with no copay, and occupational therapy has a $35 copay. The plan also covers mental health services, with a $50 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $50 copay, and additional telehealth benefits have no copay.
Preventive Services See details
Preventive Services, including Medicare-covered services, are covered with no copay; however, the Annual Physical Exam is not covered. Other covered services include Health Education, Personal Emergency Response System (PERS), In-Home Support Services, Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and OTC hearing aids have no copay. Prescription hearing aids (all types) are covered. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with a $0 copay for eye exams, and contact lenses. Eyewear has a combined maximum benefit of $300 per year.
Dental Services See details
Dental services are partially covered under the Central Health Medi-Medi Plan II (HMO D-SNP), with no copay for Medicare Dental Services, but orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Central Health Medi-Medi Plan II (HMO D-SNP) with a coinsurance of 20%. Prior authorization and a doctor referral are required.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies, both with 20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Central Health Medi-Medi Plan II (HMO D-SNP). Diagnostic Procedures/Tests and Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services have no coinsurance.
Home Health Services See details
Home Health Services are covered under the Central Health Medi-Medi Plan II (HMO D-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has no copay, and OTC items and the meal benefit also have no copay. 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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