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Central Health Classic Care Plan I (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Classic Care 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 Classic Care Plan I (HMO) 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 Classic Care Plan I (HMO) is a HMO plan offered by Central Health Plan of California, Inc. available for the 2026 plan year to people living in Counties: Ker, LA, Ora, Riv, SBD, SD. 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 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 Classic Care 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 Classic Care 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
Health deductible: information not available.
This plan has a $99.00 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 $799.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $799.00 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:
Sign up for Central Health Classic Care Plan I (HMO)
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Drug Coverage
The Central Health Classic Care Plan I (HMO) features an enhanced alternative drug benefit with an annual prescription drug deductible of $99.00. During the initial coverage phase, standard pharmacy and standard mail-order drugs cost a $2.00 copay for preferred generics, a $35.00 copay for standard generics, and a $100.00 copay for preferred brands. Non-preferred drugs require a 30% coinsurance, while specialty tier drugs have no copay. These cost-sharing rates apply until your yearly out-of-pocket drug costs reach $2,100.00, after which you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, members who qualify for the low-income subsidy, or Extra Help, will have their Part D premium reduced to zero.
Additional Benefits
The Central Health Classic Care Plan I (HMO) offers comprehensive coverage with no copay and no coinsurance for acute inpatient hospital stays, primary care visits, specialist consultations, and preventive services. Outpatient hospital services and emergency care are also highly affordable, featuring low copays ranging from no copay to $100 and no coinsurance. Additionally, diagnostic tests, lab work, and outpatient X-rays are covered with no copay or coinsurance, ensuring affordable access to essential medical evaluations. This plan also includes valuable extra benefits, such as routine vision and hearing exams with no copay, along with a $300 annual allowance for eyewear. Dental services are partially covered with no coinsurance, and members can access up to 24 one-way transportation trips per year to plan-approved locations with no copay. Durable medical equipment and diabetic supplies are highly accessible, with diabetic equipment requiring no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Central Health Classic Care Plan I (HMO), featuring no copay and no coinsurance for acute Medicare-covered stays, and daily copays with no coinsurance for psychiatric stays. Non-Medicare-covered stays, acute upgrades, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Central Health Classic Care Plan I (HMO) covers outpatient hospital and observation services with copays ranging from no copay to $65 and no coinsurance. Ambulatory surgical center and blood services feature no copays and no coinsurance, while outpatient substance abuse services are covered with a 20% coinsurance and no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Central Health Classic Care Plan I (HMO) with a $100.00 copay and no coinsurance. These services require a doctor referral and prior authorization.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Central Health Classic Care Plan I (HMO), with ground ambulance services requiring a copay of $0 to $150 and no coinsurance, while air ambulance services require a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay, though transportation to any health-related location is not covered.
Emergency Services See details
Central Health Classic Care Plan I (HMO) covers emergency services with a $100 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services are covered with no copay or coinsurance, while worldwide emergency, urgent, and transportation services require a $140 copay and no coinsurance up to a $50,000 maximum benefit limit.
Primary Care See details
Central Health Classic Care Plan I (HMO) covers primary care, specialist, chiropractic, therapy, and opioid treatment services with no copays, while additional telehealth benefits are covered with no copay and a 20% coinsurance. Podiatry, mental health specialty, and psychiatric services are not covered under this plan.
Preventive Services See details
Preventive services are covered by the Central Health Classic Care Plan I (HMO) with no copays and no coinsurance, though prior authorizations and doctor referrals are required for some benefits. However, additional preventive services are only partially covered, excluding in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, chemotherapy-related wigs, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Central Health Classic Care Plan I (HMO) partially covers hearing services, providing routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are covered up to two per year with a copay of $575 to $2,099 and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Central Health Classic Care Plan I (HMO) covers vision services with no copay or coinsurance, including one routine eye exam per year. The plan also provides up to $300 annually for eyewear, including contacts, eyeglasses, frames, lenses, and upgrades, with prior authorization and doctor referrals required.
Dental Services See details
Central Health Classic Care Plan I (HMO) offers partially covered dental services, with maxillofacial prosthetics and orthodontics being not covered. Covered dental procedures require copays ranging from no copay to $2,160 depending on the service, and there is no coinsurance.
Home Infusion bundled Services See details
Central Health Classic Care Plan I (HMO) covers home infusion bundled services with prior authorization, requiring no copay and ranging from no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Central Health Classic Care Plan I (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Central Health Classic Care Plan I (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. Diabetic equipment and therapeutic shoes have no copay and no coinsurance, while DME and prosthetics feature no copay and a coinsurance ranging from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Central Health Classic Care Plan I (HMO), with diagnostic tests, lab work, diagnostic radiology, and outpatient X-rays requiring no copay or coinsurance. Therapeutic radiological services are covered with a 20% coinsurance and no copay, and all services require prior authorization and a doctor referral.
Home Health Services See details
Central Health Classic Care Plan I (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 I (HMO) indicates some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Because these services are not covered in practice, there are no copays or coinsurance costs associated with them.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Central Health Classic Care Plan I (HMO), requiring Medicare-defined copays and coinsurance per stay, with no prior three-day hospital stay required. Prior authorization and a doctor referral are necessary, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Central Health Classic Care Plan I (HMO) partially covers Other Services, excluding Dual Eligible SNPs with Highly Integrated Services and over-the-counter Nicotine Replacement Therapy. Covered acupuncture and over-the-counter items require no copay and no coinsurance, while meal benefits feature a $0 to $5 copay and no coinsurance.
Plan Providers
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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