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Central Health Valor Care Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Central Health Valor Care Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Central Health Valor Care Plan (HMO) in 2026, please refer to our full plan details page.
Central Health Valor Care Plan (HMO) is a HMO 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 Valor Care Plan (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Central Health Valor Care Plan (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 Valor Care Plan (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. Additionally, this plan comes with a Part B Premium reduction of $79.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4400.00 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
Prescription drugs are not covered by Central Health Valor Care Plan (HMO).
Additional Benefits
The Central Health Valor Care Plan (HMO) offers comprehensive coverage with no copays for primary care, specialist visits, preventive services, and routine eye exams. Inpatient hospital stays require a $150 daily copay for the first six days and no copay thereafter, while outpatient services range from no copay up to a $295 copay with no coinsurance. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital, and urgently needed services feature no copay. Members also benefit from dental and vision coverage, including a $400 annual eyewear allowance and no copays for preventive dental care. Hearing services include routine exams at no cost, though prescription hearing aids require copays ranging from $575 to $2,099. For medical equipment and dialysis services, members will pay no copay alongside coinsurance rates ranging up to 20 percent.
Inpatient Hospital See details
Central Health Valor Care Plan (HMO) covers inpatient acute and psychiatric hospital stays with a $150 daily copay for days 1 through 6, no copay for days 7 through 90, and no coinsurance. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and both doctor referrals and prior authorizations are required.
Outpatient Services See details
Central Health Valor Care Plan (HMO) covers outpatient services with no coinsurance and copays ranging from no copay up to $295. Members will pay no copay for ambulatory surgical center, blood, and individual substance abuse services, a $10 copay for group substance abuse sessions, and up to a $295 copay for outpatient hospital and observation services.
Partial Hospitalization See details
Central Health Valor Care Plan (HMO) covers partial hospitalization services with an $85 copay and no coinsurance. Prior authorization and a doctor referral are required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Central Health Valor Care Plan (HMO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a copay ranging from no copay to $275 and no coinsurance, while air ambulance services require 20% coinsurance and no copay.
Emergency Services See details
Emergency services are covered by the Central Health Valor Care Plan (HMO) with a $130 copay and no coinsurance, which is waived if admitted to the hospital within three days. Urgently needed services feature no copay and no coinsurance, while worldwide emergency services are covered up to a $50,000 limit with a $130 copay and no coinsurance.
Primary Care See details
Central Health Valor Care Plan (HMO) provides partially covered primary care benefits with no copays and no coinsurance for primary care, specialist, therapy, and psychiatric visits, though podiatry services are not covered. Telehealth options are also covered with a copay ranging from $0 to $10 and no coinsurance.
Preventive Services See details
Central Health Valor Care Plan (HMO) partially covers preventive services with no copay and no coinsurance, though prior authorization and doctor referrals are required for certain benefits. Covered services include annual physical exams, kidney disease education, and fitness programs, whereas sub-services such as alternative therapies, weight management, and in-home support are not covered.
Hearing Services See details
Hearing services are partially covered by the Central Health Valor Care Plan (HMO), featuring annual routine exams and fitting evaluations with no copay or coinsurance. Up to two prescription hearing aids are covered per year with a copay ranging from $575 to $2,099 and no coinsurance, but OTC hearing aids and prescription models for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered by the Central Health Valor Care Plan (HMO) with no copay and no coinsurance for both eye exams and eyewear. Members are covered for one routine eye exam per year and receive a $400 annual allowance for eyewear, which includes contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Central Health Valor Care Plan (HMO) provides partially covered dental services, though maxillofacial prosthetics and orthodontics are not covered. Members pay no coinsurance, with copayments ranging from no copay for preventive services like exams and cleanings up to $2,160 for implants.
Home Infusion bundled Services See details
Central Health Valor Care Plan (HMO) covers Home Infusion bundled Services with prior authorization, featuring no copay and coinsurance ranging from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Central Health Valor Care Plan (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Central Health Valor Care Plan (HMO) covers medical equipment, including durable medical equipment and prosthetics, with 0% to 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Central Health Valor Care Plan (HMO) covers diagnostic and radiological services with prior authorization and a doctor referral. You will pay no copay and no coinsurance for lab services, diagnostic tests, and outpatient X-rays, while diagnostic radiological services carry a copay of up to $100 (with no coinsurance) and therapeutic radiological services require a 20% coinsurance (with no copay).
Home Health Services See details
Central Health Valor Care Plan (HMO) covers home health services with no copay and no coinsurance. A doctor referral and prior authorization are required to receive these benefits.
Cardiac Rehabilitation Services See details
Central Health Valor Care Plan (HMO) indicates some services are covered, but in practice, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Central Health Valor Care Plan (HMO) with no copay and Medicare-defined coinsurance, though prior authorization and a doctor referral are required. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Central Health Valor Care Plan (HMO) provides partially covered Other Services, as over-the-counter (OTC) items and dual-eligible SNPs are not covered. Covered benefits include acupuncture with no copay and no coinsurance for up to 30 treatments per year, and meal benefits with no copay to a $5 copay and no coinsurance.
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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.
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