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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 2026, 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 3 out of 5 stars in 2026.
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 $599.00 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 Jade Plan (HMO) offers an Enhanced Alternative drug benefit with no prescription drug deductible, allowing your coverage to start right away. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs and Tier 5 specialty tier drugs filled at standard pharmacies or via standard mail. For other tiers, you will pay a $35 copay for Tier 2 standard generics, a 30% coinsurance for Tier 3 preferred brands, and a 33% coinsurance for Tier 4 non-preferred drugs. These copayments and coinsurance rates apply during the initial coverage phase until your total drug costs reach $2,100.00, after which your yearly out-of-pocket costs reaching $2,100.00 will transition you to paying nothing for covered Part D drugs. Furthermore, individuals who qualify for the Low-Income Subsidy (LIS) can benefit from a reduced Part D premium of $0.00.
Additional Benefits
The Central Health Jade Plan (HMO) offers comprehensive coverage with no copay and no coinsurance for primary care visits, specialist consultations, routine outpatient services, and acute inpatient hospital stays. Members also benefit from no copay and no coinsurance on routine vision exams, annual eyewear up to three hundred dollars, routine hearing care, and select preventive services like fitness programs. Emergency room visits require a seventy-five dollar copay which is waived if admitted, while urgently needed services feature no copay. For specialized care, dental services are available with no coinsurance and copays ranging up to two thousand one hundred sixty dollars, while home health and dialysis services require no copay but carry a twenty percent coinsurance. Diagnostic labs, X-rays, and diabetic supplies are fully covered with no copay and no coinsurance, though durable medical equipment may require up to twenty percent coinsurance. Additionally, members can access routine acupuncture, over-the-counter items, and meal benefits with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered under the Central Health Jade Plan (HMO), featuring no copay and no coinsurance for acute stays, while upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care requires a $100 daily copay for days 1 to 7 (no copay for days 8 to 90) with no coinsurance, but additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by the Central Health Jade Plan (HMO) with no copay and no coinsurance, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization and a doctor referral are required for most of these covered outpatient benefits.
Partial Hospitalization See details
Central Health Jade Plan (HMO) covers partial hospitalization services with a $10.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Ambulance and Transportation Services See details
Central Health Jade Plan (HMO) partially covers ambulance and transportation services, excluding transportation to any health-related location. Ground ambulance services require a $0 to $100 copay with no coinsurance, air ambulance services require a 20% coinsurance with no copay, and plan-approved health-related transportation offers 24 one-way trips per year with no copay and no coinsurance.
Emergency Services See details
Central Health Jade Plan (HMO) covers emergency services with a $75 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services feature no copay or coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum limit with a $50 copay and no coinsurance.
Primary Care See details
The Central Health Jade Plan (HMO) covers primary care, specialist, podiatry, and therapy services with no copay and no coinsurance, though chiropractic services are only partially covered as routine chiropractic care is not covered. Mental health, psychiatric, and telehealth services are also covered with copays up to $10 and no coinsurance.
Preventive Services See details
Central Health Jade Plan (HMO) partially covers preventive services with no copays and no coinsurance for covered benefits, though some services require prior authorization or referrals. Covered benefits include fitness programs, glaucoma screenings, and kidney disease education, while an annual physical exam, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy-related wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, telemonitoring, home safety modifications, and counseling services are not covered.
Hearing Services See details
Central Health Jade Plan (HMO) covers hearing services with no copays and no coinsurance for routine exams, fitting evaluations, and over-the-counter hearing aids. Prescription hearing aids are partially covered, requiring prior authorization and a doctor referral, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Central Health Jade Plan (HMO) covers routine eye exams and eyewear, including contacts and eyeglasses, with no copay, no coinsurance, and no deductible. Members are eligible for one annual routine eye exam and up to $300 per year in combined eyewear coverage, subject to prior authorization and doctor referrals.
Dental Services See details
Dental services are partially covered by the Central Health Jade Plan (HMO), with no coverage for maxillofacial prosthetics and orthodontics. Covered dental benefits range from no copay up to a $2,160 copay, with no coinsurance required.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Central Health Jade Plan (HMO) with prior authorization and step therapy required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Central Health Jade Plan (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these benefits.
Medical Equipment See details
Medical equipment is covered under the Central Health Jade Plan (HMO), with prior authorization required for these services. Durable medical equipment features no copay and ranges from no coinsurance to 20% coinsurance, while prosthetics and medical supplies require no copay and a 10% to 20% coinsurance. Diabetic supplies, therapeutic shoes, and inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Central Health Jade Plan (HMO) covers diagnostic and radiological services, requiring prior authorization and a doctor referral. Members pay no copay and no coinsurance for lab services, outpatient X-rays, diagnostic tests, and diagnostic radiological services, while therapeutic radiological services carry a 20% coinsurance and no copay.
Home Health Services See details
Central Health Jade Plan (HMO) covers Home Health Services with no copayment and a 20% coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Central Health Jade Plan (HMO) does not cover Cardiac Rehabilitation Services, as all specific sub-services—including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD)—are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Central Health Jade Plan (HMO) under Medicare-defined copays and coinsurance, requiring prior authorization and a doctor referral. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Central Health Jade Plan (HMO) partially covers other services, providing acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. However, dual eligible SNPs with highly integrated services and certain CMS over-the-counter list drugs are not covered.
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