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Central Health Premier Plan I (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Premier Plan I (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Central Health Premier Plan I (HMO) in 2025, please refer to our full plan details page.
Central Health Premier Plan I (HMO) is a HMO plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Select counties in Northern CA. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Central Health Premier Plan I (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 Premier Plan I (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 Premier Plan I (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 $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 Premier Plan I (HMO) has a $100 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay no copay for preferred generic drugs and specialty tier drugs at standard and mail order pharmacies, and a $35 copay for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. This plan may also reduce your premium if you qualify for the low-income subsidy.
Additional Benefits
The Central Health Premier Plan I (HMO) offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have no copay for most days, while outpatient services and emergency services have varying copays. This plan includes no copays for many services, such as primary care, preventive services, hearing exams, vision exams, and many dental services. The plan also covers ambulance, transportation, home health, and medical equipment, with some services having copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a doctor referral and prior authorization required. For days 1-4 and 11-90, there is no copay, but there is a $100 copay for days 5-10.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital and observation services have a copay between $0 and $225 per visit, and ambulatory surgical center services and outpatient blood services have no copay. Outpatient substance abuse services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Central Health Premier Plan I (HMO) with a $10 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services. Ground ambulance services have a copay between $0 and $300, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Central Health Premier Plan I (HMO). Emergency Services have a copay between $0 and $125, Urgently Needed Services have no copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a copay of $125.
Primary Care See details
The Central Health Premier Plan I (HMO) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and additional telehealth benefits have no copay. Occupational therapy services, and physical therapy and speech-language pathology services have a $20 copay, while mental health specialty services and psychiatric services have a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, and additional preventive services, although annual physical exams are not covered. Additional services like health education, in-home safety assessments, personal emergency response systems, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
The Central Health Premier Plan I (HMO) offers hearing services, including hearing exams and OTC hearing aids with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $2000 per year, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with no copay for eye exams and eyewear. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered. There is a combined maximum of $300 per year for eyewear.
Dental Services See details
The Central Health Premier Plan I (HMO) covers Medicare Dental Services with no copay, and other dental services including oral exams with a copay of $0-$17, dental x-rays with a copay of $0-$41, other diagnostic dental services with a copay of $0-$15, prophylaxis (cleaning) with no copay, fluoride treatment with a copay of $0-$13, and other preventive dental services with no copay. Restorative services are covered with a copay of $0-$424, adjunctive general services with a copay of $0-$166, endodontics and periodontics with no copay, prosthodontics (removable) with a copay of $0-$220, implant services with a copay of $0-$2160, prosthodontics (fixed) with a copay of $75-$295, and oral and maxillofacial surgery with a copay of $0-$237. 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis services are covered under the Central Health Premier Plan I (HMO), but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Central Health Premier Plan I (HMO) covers medical equipment, including Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is also covered, with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Central Health Premier Plan I (HMO) covers diagnostic and radiological services, including diagnostic procedures and lab services with no copay. Outpatient X-ray services have no copay, and therapeutic radiological services have a 20% coinsurance. Diagnostic radiological services have a maximum copay of $150.00.
Home Health Services See details
Home Health Services are covered by the Central Health Premier Plan I (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 under the Central Health Premier Plan I (HMO), including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Central Health Premier Plan I (HMO) and require prior authorization and a doctor's referral. The plan does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays.
Other Services See details
Other Services includes acupuncture, over-the-counter items, and meal benefits. Acupuncture has no copay and no coinsurance, while over-the-counter items and meal benefits also have no copay, and no coinsurance. However, this 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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, or Self-Directed Personal Assistance Services.
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