A non-government entity
Central Health Classic Care Plan IV (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Classic Care Plan IV (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Central Health Classic Care Plan IV (HMO) in 2026, please refer to our full plan details page.
Central Health Classic Care Plan IV (HMO) is a HMO plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in San Francisco and San Mateo Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Central Health Classic Care Plan IV (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 Classic Care Plan IV (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 Classic Care Plan IV (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 a $100.00 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 $2499.00 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 Classic Care Plan IV (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 Classic Care Plan IV (HMO) features an Enhanced Alternative drug benefit with a prescription drug deductible of $100.00. After meeting this deductible, you enter the initial coverage phase where standard pharmacy and standard mail orders cost a $2.00 copay for preferred generics, a $35.00 copay for standard generics, and a $100.00 copay for preferred brands. Additionally, non-preferred drugs require a 30% coinsurance, while specialty tier drugs feature no copay. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, if you qualify for the low-income subsidy, your Part D cost is reduced to $0.00. Please check the plan's formulary to see if your specific prescription drugs are covered.
Additional Benefits
The Central Health Classic Care Plan IV (HMO) offers comprehensive coverage with no plan deductibles and no copays for primary care visits, preventive services, and home health care. For specialized medical needs, members pay a low 10 dollar copay for specialist visits, while inpatient hospital stays require a daily copay for the first six days with no coinsurance. Emergency care is covered with a 150 dollar copay that is waived if you are admitted, and outpatient services carry no coinsurance. This plan also features robust supplemental benefits, including routine eye exams, dental cleanings, acupuncture, and up to 12 one-way transportation trips per year with no copays. Routine hearing exams and over-the-counter hearing aids are also available with no copay, though prescription hearing aids and advanced dental services require copayments. While dialysis and durable medical equipment may require up to a 20 percent coinsurance, cardiac rehabilitation services are not covered by this plan.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Central Health Classic Care Plan IV (HMO) with no coinsurance, requiring a $200 daily copay for days 1 to 6 of acute stays and a $225 daily copay for days 1 to 6 of psychiatric stays, followed by no copay for days 7 to 90. Prior authorization and doctor referrals are required, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by the Central Health Classic Care Plan IV (HMO) with no coinsurance and no deductibles. Copays range from no copay for ambulatory surgical center and blood services to $10 for substance abuse sessions and up to $250 for outpatient hospital and observation services.
Partial Hospitalization See details
Central Health Classic Care Plan IV (HMO) covers partial hospitalization benefits with a $100 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Central Health Classic Care Plan IV (HMO), with transportation being partially covered as trips to non-plan-approved health locations are not covered. Ground ambulance services require a copay of $0 to $250 and no coinsurance, air ambulance services require a 20% coinsurance and no copay, and approved transportation services offer up to 12 one-way trips per year with no copay and no coinsurance.
Emergency Services See details
Central Health Classic Care Plan IV (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services have no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 limit with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by the Central Health Classic Care Plan IV (HMO), as podiatry services are not covered. There is no copay and no coinsurance for primary care doctor visits, occupational therapy, and physical therapy, while specialist visits require a $10 copay with no coinsurance, and psychiatric group sessions cost a $25 copay and 20% coinsurance.
Preventive Services See details
Central Health Classic Care Plan IV (HMO) partially covers preventive services with no copays or coinsurance, though some services require referrals or prior authorization. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, telemonitoring, home modifications, and counseling.
Hearing Services See details
Central Health Classic Care Plan IV (HMO) covers hearing exams and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $575.00 to $2,099.00 and no coinsurance, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Central Health Classic Care Plan IV (HMO) covers vision services, including one routine eye exam and eyewear such as contacts and eyeglasses annually, with no copay and no coinsurance. The plan provides a combined maximum coverage of $200 per year for eyewear, and both exams and eyewear require prior authorization and a doctor referral.
Dental Services See details
Central Health Classic Care Plan IV (HMO) offers partially covered dental services with no coinsurance and copayments ranging from no copay for preventive care up to $2,160 for implants. Maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Central Health Classic Care Plan IV (HMO) covers home infusion bundled services with prior authorization, offering chemotherapy, radiation, and other Medicare Part B drugs with no copay and ranging from no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are also covered with a $35 copay and ranging from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Central Health Classic Care Plan IV (HMO) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Medical Equipment benefits are covered by the Central Health Classic Care Plan IV (HMO), with durable medical equipment, prosthetics, and medical supplies requiring no copay and ranging from no coinsurance to 20% coinsurance. Diabetic supplies, therapeutic shoes, and inserts are also covered with no copay and no coinsurance, though prior authorization is required for these medical equipment services.
Diagnostic and Radiological Services See details
Central Health Classic Care Plan IV (HMO) covers diagnostic and radiological services, with prior authorization and doctor referrals required. There is no copay or coinsurance for diagnostic tests, lab services, and outpatient X-rays, though diagnostic radiological services require a copay up to $200 with no coinsurance, and therapeutic radiological services carry a 20% coinsurance with no copay.
Home Health Services See details
Home health services are covered by the Central Health Classic Care Plan IV (HMO) with no copay and no coinsurance. Access to these covered services requires a doctor referral and prior authorization.
Cardiac Rehabilitation Services See details
Central Health Classic Care Plan IV (HMO) does not cover Cardiac Rehabilitation Services, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered. Because these services are not covered by the plan, there are no copays or coinsurance costs.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Central Health Classic Care Plan IV (HMO), as additional days beyond the Medicare-covered limit are not covered. Covered SNF stays require prior authorization and a doctor referral, featuring Medicare-defined coinsurance and no copay per admission.
Other Services See details
Central Health Classic Care Plan IV (HMO) partially covers other services, providing acupuncture, meal benefits, and over-the-counter (OTC) items with no copay and no coinsurance. However, Nicotine Replacement Therapy (NRT) and Dual Eligible SNPs with Highly Integrated Services are not covered.
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