Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Embrace Choice Plan (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Central Health Embrace Choice Plan (HMO C-SNP) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Central Health Embrace Choice Plan (HMO C-SNP) is a HMO C-SNP plan offered by Central Health Plan of California, Inc. available for the 2026 plan year 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 Embrace Choice Plan (HMO C-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 Embrace Choice Plan (HMO C-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.
Below are a few key facts and commonly-asked questions about Central Health Embrace Choice Plan (HMO C-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
For Central Health Embrace Choice Plan (HMO C-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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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.
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
The Central Health Embrace Choice Plan (HMO C-SNP) features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you enter the initial coverage phase where standard pharmacies and standard mail orders require a 15% coinsurance for both preferred and standard generic drugs. During this phase, you will pay a 30% coinsurance for preferred brands, a 25% coinsurance for non-preferred drugs, and no copay for specialty tier drugs. Once your yearly drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, individuals who qualify for the low-income subsidy, or LIS, will have their Part D premium reduced to $0.
The Central Health Embrace Choice Plan (HMO C-SNP) offers robust coverage with no copay and no coinsurance for primary care visits, preventive services, home health care, and routine vision and dental care. Outpatient services, diagnostic lab tests, and X-rays also feature no copays, though some outpatient hospital and specialist services may require coinsurance up to 20% or copays up to $30. Emergency care is available with a $115 copay, which is waived upon hospital admission, while urgently needed care requires no copay or coinsurance. For specialized needs, the plan covers routine hearing exams and over-the-counter hearing aids with no copay or coinsurance, while prescription hearing aids require copays ranging from $49 to $1,549. Durable medical equipment, dialysis, and ambulance services are subject to a 20% coinsurance with no copays. Additionally, members benefit from up to 12 one-way transportation trips per year, select over-the-counter items, and acupuncture, all with no copays or coinsurance.
Inpatient hospital services are partially covered by the Central Health Embrace Choice Plan (HMO C-SNP) using Medicare-defined copays and coinsurance, though additional acute hospital days have no coinsurance. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization and doctor referrals are required.
Outpatient services are covered by the Central Health Embrace Choice Plan (HMO C-SNP) with no copays across all included benefits. Members will pay a 0% to 20% coinsurance for outpatient hospital and observation services, a 20% coinsurance for outpatient substance abuse services, and no coinsurance for ambulatory surgical center and outpatient blood services.
Central Health Embrace Choice Plan (HMO C-SNP) covers partial hospitalization benefits with a copay ranging from $105.00 to $110.00 and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Central Health Embrace Choice Plan (HMO C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Central Health Embrace Choice Plan (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services are available with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $50,000 with a $110 copay and no coinsurance.
Central Health Embrace Choice Plan (HMO C-SNP) covers primary care, therapies, chiropractic, podiatry, and mental health services with no copay and no coinsurance for most visits. Specialist and telehealth services may require a copay ranging up to $30 or coinsurance ranging from no coinsurance to 30% coinsurance.
Central Health Embrace Choice Plan (HMO C-SNP) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physicals, fitness, health education, and kidney disease education. Sub-services that are not covered include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing services are covered by the Central Health Embrace Choice Plan (HMO C-SNP), offering routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $49 to $1,549 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Central Health Embrace Choice Plan (HMO C-SNP) covers vision services with no copay, no coinsurance, and no deductible for annual routine eye exams and eyewear. Covered eyewear includes contact lenses, eyeglasses, lenses, frames, and upgrades, up to a combined maximum allowance of $300 every year.
Central Health Embrace Choice Plan (HMO C-SNP) covers comprehensive and preventive dental services with no copay and no coinsurance. The plan offers an annual maximum benefit of $1,600 for other dental services, though prior authorization is required for several procedures.
Central Health Embrace Choice Plan (HMO C-SNP) covers Home Infusion bundled Services, which require prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis services are covered by the Central Health Embrace Choice Plan (HMO C-SNP) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access this benefit.
Central Health Embrace Choice Plan (HMO C-SNP) covers medical equipment, requiring prior authorization for all services. Durable medical equipment and prosthetics are subject to a 20% coinsurance and no copay, whereas diabetic supplies and therapeutic shoes are provided with no copay and no coinsurance.
Central Health Embrace Choice Plan (HMO C-SNP) covers diagnostic and radiological services with no copays, requiring prior authorization and doctor referrals. Lab services and outpatient X-rays have no coinsurance, while other diagnostic and radiological services carry a coinsurance ranging from 0% to 20%.
Home Health Services are covered under the Central Health Embrace Choice Plan (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive these benefits.
Cardiac Rehabilitation Services are not covered under the Central Health Embrace Choice Plan (HMO C-SNP). Because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered, there are no plan copays or coinsurance available for these treatments.
Central Health Embrace Choice Plan (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services, though additional days beyond Medicare-covered days are not covered. Prior authorization and a doctor referral are required, and patients are subject to Medicare-defined coinsurance and cost-sharing per stay, with no cost-sharing charged on the day of discharge.
Central Health Embrace Choice Plan (HMO C-SNP) provides partial coverage for other services with no copay or coinsurance, including acupuncture, over-the-counter items, and meal benefits. Highly integrated services for dual eligible SNPs are not covered under this benefit, and some covered services require prior authorization or a doctor referral.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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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.
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