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Central Health Classic Care Plan III (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Classic Care Plan III (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 III (HMO) in 2026, please refer to our full plan details page.
Central Health Classic Care Plan III (HMO) is a HMO plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Counties: Pla, Sac, SJqn, StCla, Sol, Stan, Yolo. 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 III (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 III (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 III (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 $125.00 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 $2999.00 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 Classic Care Plan III (HMO) features an enhanced alternative drug benefit with an annual prescription drug deductible of $125. After meeting this deductible, you will enjoy no copay for Tier 1 preferred generic and Tier 5 specialty drugs when using standard retail or mail-order pharmacies. Other medication tiers require coinsurance, which includes 15% for Tier 2 standard generics, 30% for Tier 3 preferred brands, and 31% for Tier 4 non-preferred drugs. These initial coverage rates apply until your yearly drug costs reach $2,100. Once you reach this limit, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs. Additionally, if you qualify for the low-income subsidy, you may benefit from a reduced premium and no cost-sharing.
Additional Benefits
The Central Health Classic Care Plan III (HMO) offers robust medical coverage designed to keep your out-of-pocket costs low by featuring no copay for many everyday services. Members pay no copay for primary care doctor visits, annual preventive exams, routine dental cleanings, and routine vision and hearing tests. For emergency care, there is a $150 copay, while inpatient hospital stays require a $195 daily copay for the first six days and no copay for days seven through ninety. Additionally, you will pay no copay for home health services, diabetic supplies, acupuncture, and over-the-counter items. Other specialized services like durable medical equipment and dialysis require a 0% to 20% coinsurance, with no copay. This plan balances predictable copays for major medical events with extensive no-copay benefits for your routine healthcare needs.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Central Health Classic Care Plan III (HMO), requiring a $195 daily copay for days 1 through 6, no copay for days 7 through 90, and no coinsurance for acute and psychiatric stays. Prior authorization and referrals are required, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Central Health Classic Care Plan III (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $250, observation services incur a $250 copay per stay, and outpatient substance abuse sessions have a $10 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Central Health Classic Care Plan III (HMO) with a $100 copay and no coinsurance. Accessing this covered service requires a doctor referral and prior authorization.
Ambulance and Transportation Services See details
Central Health Classic Care Plan III (HMO) covers ground ambulance services with a $0 to $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by Central Health Classic Care Plan III (HMO) with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services are provided with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $150 copay and no coinsurance per service.
Primary Care See details
Central Health Classic Care Plan III (HMO) partially covers primary care benefits with no coinsurance and copays ranging from no copay up to $25. While services such as primary care physician visits, physical therapy, and occupational therapy require no copay, podiatry services are not covered by this plan.
Preventive Services See details
Central Health Classic Care Plan III (HMO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, fitness, and health education. Sub-services not covered under this plan include in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, home modifications, and counseling.
Hearing Services See details
Central Health Classic Care Plan III (HMO) covers hearing services with no copay or coinsurance for annual routine exams, fitting evaluations, and unlimited OTC hearing aids. Prescription hearing aids are partially covered with a copay ranging from $575 to $2,099 and no coinsurance for up to two devices per year, while inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Central Health Classic Care Plan III (HMO) covers annual routine eye exams and eyewear with no copay and no coinsurance. The plan provides a combined maximum coverage limit of $200 per year for contact lenses, eyeglass lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Central Health Classic Care Plan III (HMO), as maxillofacial prosthetics and orthodontics are not covered. There is no coinsurance for any covered dental benefits, which feature no copay for Medicare dental, oral exams, cleanings, fluoride, and x-rays, and copays ranging from $0 to $2,160 for other diagnostic, preventive, and restorative services.
Home Infusion bundled Services See details
Central Health Classic Care Plan III (HMO) partially covers Home Infusion bundled Services with prior authorization, as Part D home infusion drugs are not covered as a bundled mandatory supplemental benefit. Covered Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance and no copay, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Central Health Classic Care Plan III (HMO) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Central Health Classic Care Plan III (HMO) covers durable medical equipment and prosthetics with 0% to 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance, with prior authorization required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Central Health Classic Care Plan III (HMO) covers diagnostic and radiological services with prior authorization and a doctor referral. Members pay no copay and no coinsurance for lab services, diagnostic tests, and outpatient X-rays, while diagnostic radiological services have a copay of $0 to $200 (with no coinsurance) and therapeutic radiological services require a 20% coinsurance (with no copay).
Home Health Services See details
Central Health Classic Care Plan III (HMO) covers home health services with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Central Health Classic Care Plan III (HMO) indicates some services are covered, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Any covered services under this benefit require prior authorization and a doctor referral, with no copay and no coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Central Health Classic Care Plan III (HMO), as additional days beyond standard Medicare-covered days are not covered. Eligible stays require prior authorization and a referral, featuring no copay and Medicare-defined coinsurance per stay.
Other Services See details
Other Services are partially covered under the Central Health Classic Care Plan III (HMO), which offers acupuncture and over-the-counter items with no copay or coinsurance, as well as meal benefits with a $0 to $5 copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services and nicotine replacement therapy are not covered.
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