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Central Health Dual Access Plan (HMO D-SNP)

Benefits Summary and Overview

This page is a benefits summary and overview of key plan information for Central Health Dual Access Plan (HMO D-SNP). The information on this page is a summary only.

For a complete listing of all available benefits and cost information on Central Health Dual Access Plan (HMO D-SNP) in 2026, please refer to our full plan details page.

Central Health Dual Access Plan (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Select counties in CA. This plan received an overall rating of 3 out of 5 stars in 2026.

It's important to know that Central Health Dual Access Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Important:

Central Health Dual Access Plan (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.

Overview IconKey Plan Facts

Below are a few key facts and commonly-asked questions about Central Health Dual Access Plan (HMO D-SNP).

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 Dual Access Plan (HMO D-SNP), 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 $550.00 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 $9250.00 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:

Regular visits to your primary care doctor are covered and will have a copay of and coinsurance of 30%.

Specialist Visits:

Visits to specialists are covered and will have a copay of and coinsurance of 30%. Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a copay of and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care arecovered and will have a copay of and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for Central Health Dual Access Plan (HMO D-SNP)

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Drug Coverage IconDrug Coverage

The Central Health Dual Access Plan (HMO D-SNP) features an Enhanced Alternative drug benefit with a $550.00 annual prescription drug deductible. If you qualify for the Low-Income Subsidy (LIS), your Part D premium and LIS Full cost-sharing are reduced to $0.00. During the initial coverage phase, which lasts until total drug costs reach $2,100.00, you will pay a $2.00 copay for Tier 1 preferred generics and no copay for Tier 5 specialty drugs at standard pharmacies or through standard mail. For other tiers, standard pharmacy and mail-order costs include a 20% coinsurance for Tier 2 standard generics, 30% coinsurance for Tier 3 preferred brands, and 25% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescription drugs.

Additional Benefits IconAdditional Benefits

The Central Health Dual Access Plan (HMO D-SNP) offers comprehensive medical coverage featuring no copayments for inpatient hospital stays, outpatient blood services, and home health services. Many outpatient, ambulance, and dialysis services require a 20% coinsurance with no copay, while emergency care carries a $115 copay that is waived upon hospital admission. Diagnostic and radiological services are also available with no copays, though some procedures and medical equipment require a 20% coinsurance. Members benefit from robust supplemental coverage, including routine vision exams, eyewear with a $200 annual allowance, and routine hearing services with unlimited over-the-counter hearing aids, all with no copay and no coinsurance. Preventive care, Medicare dental services, acupuncture, and up to 24 yearly one-way transportation trips to plan-approved locations are also covered with no copay or coinsurance. However, the plan does not cover cardiac rehabilitation, podiatry, or specialized dental procedures like implants and orthodontics.

Inpatient Hospital See details

Inpatient hospital services are partially covered by the Central Health Dual Access Plan (HMO D-SNP), requiring doctor referrals, prior authorization, and Medicare-defined deductibles and coinsurance per stay with no copay. Specific sub-services including additional days, non-Medicare-covered stays, and acute care upgrades are not covered.

Outpatient Services See details

Central Health Dual Access Plan (HMO D-SNP) covers outpatient hospital, observation, ambulatory surgical center, and substance abuse services with a 20% coinsurance and no copay. Outpatient blood services are also covered with no copay, no coinsurance, and no deductible.

Partial Hospitalization See details

Central Health Dual Access Plan (HMO D-SNP) covers partial hospitalization benefits with an $80 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.

Ambulance and Transportation Services See details

Ambulance and transportation services are partially covered by the Central Health Dual Access Plan (HMO D-SNP), as transportation to any health-related location is not covered. Ground and air ambulance services require a 20% coinsurance and no copay, while up to 24 yearly one-way trips to plan-approved locations are covered with no copay and no coinsurance.

Emergency Services See details

Central Health Dual Access Plan (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $115 copay.

Primary Care See details

Primary Care benefits are partially covered by the Central Health Dual Access Plan (HMO D-SNP), as podiatry services are not covered. For covered services, members will pay coinsurance ranging from no coinsurance up to 50% and copays ranging from no copay for telehealth and chiropractic care up to $55 for physical therapy and psychiatric sessions.

Preventive Services See details

Preventive services are partially covered by Central Health Dual Access Plan (HMO D-SNP) with no copay and no coinsurance for covered services like annual physical exams, fitness benefits, and kidney disease education. However, sub-services such as in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling are not covered.

Hearing Services See details

Hearing services are covered by the Central Health Dual Access Plan (HMO D-SNP), offering routine hearing exams, fitting evaluations, and unlimited OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $49 and $1,549, though inner ear, outer ear, and over-the-ear devices are not covered.

Vision Services See details

Central Health Dual Access Plan (HMO D-SNP) covers vision services with no copay and no coinsurance for both eye exams and eyewear. The plan provides one routine eye exam annually and a $200 yearly allowance for eyewear, including glasses and contact lenses, with prior authorization and doctor referrals required.

Dental Services See details

Dental services are partially covered by the Central Health Dual Access Plan (HMO D-SNP), offering Medicare dental services with no copay and no coinsurance, subject to prior authorization. However, several sub-services are not covered, including orthodontics, restorative, adjunctive general, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implants, and oral and maxillofacial surgery.

Home Infusion bundled Services See details

Central Health Dual Access Plan (HMO D-SNP) covers home infusion bundled services with prior authorization, offering chemotherapy, radiation, and other Part B drugs with no copay and 0% to 20% coinsurance. Medicare Part B insulin drugs are also covered under this plan with a $35 copay and 0% to 20% coinsurance.

Dialysis Services See details

Central Health Dual Access Plan (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. A doctor referral and prior authorization are required to receive these covered services.

Medical Equipment See details

Medical Equipment benefits are covered by the Central Health Dual Access Plan (HMO D-SNP), with prior authorization required for most services. Durable medical equipment, prosthetic devices, and medical supplies require a 20% coinsurance and no copay, while diabetic supplies and therapeutic shoes or inserts are available with no copay and no coinsurance.

Diagnostic and Radiological Services See details

Central Health Dual Access Plan (HMO D-SNP) covers diagnostic and radiological services with no copays, though prior authorization and doctor referrals are required. While lab services feature no coinsurance, other diagnostic procedures, radiological services, and outpatient X-rays require a 20% coinsurance.

Home Health Services See details

Home Health Services are covered by the Central Health Dual Access Plan (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.

Cardiac Rehabilitation Services See details

Central Health Dual Access Plan (HMO D-SNP) does not cover Cardiac Rehabilitation Services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).

Skilled Nursing Facility (SNF) See details

Central Health Dual Access Plan (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and a Medicare-defined coinsurance per admission. Prior authorization and a doctor referral are required, and while no prior hospital stay is needed, additional days beyond Medicare-covered SNF care are not covered.

Other Services See details

Other Services are partially covered by Central Health Dual Access Plan (HMO D-SNP) with no copay and no coinsurance for acupuncture, over-the-counter items, and meal benefits. Highly integrated services for Dual Eligible SNPs and nicotine replacement therapy are not covered.

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