A non-government entity
Central Health Jade Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Jade 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 Jade Plan (HMO) in 2025, please refer to our full plan details page.
Central Health Jade Plan (HMO) is a HMO plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Los Angeles County. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Central Health Jade 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 Jade 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 Jade 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 $999.00 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 Jade 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 Jade Plan (HMO) has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, you will have no copay for preferred generic drugs at a standard or mail pharmacy, while you will pay a $35 copay for standard generic drugs at either a standard or mail pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Central Health Jade Plan (HMO) offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have no copay for acute care, and outpatient services, including substance abuse and blood services, are also covered with no copay. The plan includes coverage for emergency services, primary care, preventive services, hearing, vision, and dental services, with varying copays or coinsurance depending on the service. Additionally, the plan covers ambulance and transportation services, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health services, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits with the Central Health Jade Plan (HMO) cover Inpatient Hospital-Acute, with no copay for a Medicare-covered stay, and Inpatient Hospital Psychiatric, with a $100 copay for days 1-7, and no copay for days 8-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have no copay, while outpatient substance abuse services have no copay for both individual and group sessions, and outpatient blood services also have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, requiring prior authorization and a doctor's referral. The copay for this benefit is $10.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a copay between $0 and $100, while air ambulance services have a 20% coinsurance; transportation services to plan-approved health-related locations are covered with no copay, up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Central Health Jade Plan (HMO). Emergency Services have a copay between $0 and $75, while Urgently Needed Services have no copay. Worldwide Emergency Services has a $50 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with a maximum plan benefit of $100,000.
Primary Care See details
The Central Health Jade Plan (HMO) covers a variety of primary care services, including primary care physician services and occupational therapy services, with no copay; however, routine chiropractic care is not covered. The plan also covers physician specialist, podiatry, and other mental health and psychiatric services with a $0-$10 copay, as well as physical therapy and speech-language pathology services with no copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, additional preventive services with a copay, and kidney disease education services 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 benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, and telemonitoring services are not covered. Other preventive services include 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 exams are covered with no copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a maximum benefit of $3,000 per year, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with no copay.
Vision Services See details
The Central Health Jade Plan (HMO) covers vision services, including eye exams and eyewear. Eye exams and routine eye exams have no copay, and eyewear has a combined maximum plan benefit of $300 per year, with no copay.
Dental Services See details
The Central Health Jade Plan (HMO) covers various dental services. Oral exams have a copay between $0 and $17, while dental x-rays have a copay between $0 and $41. Prophylaxis (cleaning), other preventive dental services, endodontics, and periodontics have no copay. Restorative services have a copay between $0 and $424, and implant services have a copay between $0 and $2160. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
The Central Health Jade Plan (HMO) covers Home Infusion bundled Services, 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 coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered by the Central Health Jade Plan (HMO), including Durable Medical Equipment (DME) with 0-20% coinsurance, Prosthetic Devices with 10-20% coinsurance, and Medical Supplies with 10-20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Lab Services have no copay, while Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Central Health Jade 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 Jade Plan (HMO). Prior authorization and a doctor referral are required for these services.
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. The plan requires prior authorization and a doctor referral for SNF services, and the coinsurance details are not provided in this summary.
Other Services See details
The Central Health Jade Plan (HMO) covers acupuncture with no copay, and over-the-counter items with no copay. The plan also covers a meal benefit with a copay of $0 - $5, and provides nicotine replacement therapy and Naloxone coverage. The plan does not cover 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, 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.
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