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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 2025, 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 2.5 out of 5 stars in 2025.
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 $75.00. 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 $4999.00 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 including inpatient hospital stays with a copay, outpatient services, and emergency care. Many services have no copay, including primary care, preventive services, hearing exams, vision exams and eyewear, Medicare dental services, medical equipment, home health services, and acupuncture. This plan also offers coverage for ambulance services, with varying copays, and covers home infusion services and dialysis services. Diagnostic and radiological services are covered, with a mix of copays and coinsurance. However, this plan does not cover some services like cardiac rehabilitation services, and some other services listed in the text are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a $285 copay for days 1-6 and no copay for days 7-90. Additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $295, and observation services, with a copay between $0 and $295. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services are covered, with individual sessions having no copay and group sessions having a $10 copay. Outpatient blood services are also covered, with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Central Health Valor Care Plan (HMO), with a $85 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Central Health Valor Care Plan (HMO). Ground ambulance services have a copay between $0 and $275, while air ambulance services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Central Health Valor Care Plan (HMO). Emergency Services have a copay between $0 and $125, and Urgently Needed Services have no copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The Central Health Valor Care Plan (HMO) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, health education, personal emergency response systems, fitness benefits, enhanced disease management, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits. Other preventive services, such as in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, and telemonitoring services are not covered.
Hearing Services See details
The Central Health Valor Care Plan (HMO) covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams and eyewear have no copay, and routine eye exams are covered once per year. Eyewear has a combined maximum plan benefit of $150 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with no copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay, and restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, implant services, prosthodontics, fixed, and oral and maxillofacial surgery, which have copays that vary. 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 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Central Health Valor Care Plan (HMO), but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, with no copay. Durable Medical Equipment (DME) has a coinsurance of 0-20%, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay of at most $100, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered by the Central Health Valor Care Plan (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Central Health Valor Care Plan (HMO). Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but require prior authorization and a doctor referral. This plan does not cover additional days beyond Medicare-covered SNF, nor does it cover non-Medicare-covered SNF stays.
Other Services See details
The Central Health Valor Care Plan (HMO) covers acupuncture with no copay, and a limit of 30 treatments per year. The plan also covers a meal benefit with a copay between $0 and $5, but does not cover Over-the-Counter (OTC) items, 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, and Self-Directed Personal Assistance Services.
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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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