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Central Health Savings Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Savings 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 Savings Plan (HMO) in 2025, please refer to our full plan details page.
Central Health Savings Plan (HMO) is a HMO plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Counties: LA, ORA, RS, SBD. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Central Health Savings 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 Savings 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 Savings 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. Additionally, this plan comes with a Part B Premium reduction of $120.00. You must continue to pay paying your reduced 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 $3500.00 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 Savings Plan (HMO) has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy, but a $35 copay for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. The plan also notes that if you qualify for the low-income subsidy (LIS), you will also pay no cost for your Part D drugs.
Additional Benefits
The Central Health Savings Plan (HMO) offers a range of benefits with varying costs. Inpatient hospital stays have a copay, but many outpatient services, like outpatient blood services, have no copay. Emergency services, including worldwide emergency coverage, are covered with copays, while primary care, preventive services, and home health services often have no copay. This plan includes coverage for hearing, vision, and dental services, with no copays for eye exams, cleanings, and hearing exams. The plan also covers medical equipment, home infusion services, and diagnostic services with a mix of copays and coinsurance. Additionally, the plan covers some services like acupuncture and over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, the copay is $175, and for days 6-90, there is no copay. Additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services and Observation Services, are covered with a copay between $0 and $225. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered with no copay, while Outpatient Substance Abuse Services have a $5 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Central Health Savings Plan (HMO). Ground ambulance services have a copay between $0 and $155, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services with the Central Health Savings Plan (HMO) includes no coinsurance and a copay between $0 and $140, depending on the service, and Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services has a $140 copay 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, and Chiropractic Services with no copay, but routine chiropractic care is not covered. Occupational Therapy Services have a $10 copay, and Physician Specialist Services have a $25 copay. Mental Health Specialty Services, Individual and Group Sessions for Mental Health Specialty Services have a $35 copay. Other Health Care Professional services have a copay between $0 and $25. Psychiatric Services, Individual and Group Sessions for Psychiatric Services have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a $10 copay. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services are covered, but annual physical exams are not. Medicare-covered preventive services, including health education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, have no copay. Additional preventive services have no copay for services such as health education, personal emergency response system, and fitness benefits.
Hearing Services See details
The Central Health Savings Plan (HMO) covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $2000 every year, and OTC hearing aids are covered with no copay. However, prescription hearing aids for the inner, outer, and over-the-ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear, with a $0 copay for eye exams. Eyewear has a combined maximum benefit of $300 per year, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
The Central Health Savings Plan (HMO) covers dental services, including oral exams with a copay of $0-$17, dental x-rays with a copay of $0-$41, and cleanings with no copay, among others. 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 have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Central Health Savings Plan (HMO), but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Central Health Savings Plan (HMO), including Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, and Prosthetics/Medical Supplies with no copay and a coinsurance of 10% to 20%. Diabetic Equipment is also covered, with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
The Central Health Savings Plan (HMO) covers diagnostic and radiological services, including diagnostic procedures/tests with no copay, lab services with no copay, diagnostic radiological services with a copay of at most $100, therapeutic radiological services with at most 20% coinsurance, and outpatient X-ray services with no copay. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered by the Central Health Savings 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 Savings Plan (HMO). Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Central Health Savings Plan (HMO), but require prior authorization and a doctor's referral. The plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Other Services See details
The Central Health Savings Plan (HMO) covers acupuncture with no copay and also covers over-the-counter items with no copay, including nicotine replacement therapy and naloxone. However, meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, private duty nursing services, and several other services are not covered.
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