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PHP (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PHP (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PHP (HMO C-SNP) in 2026, please refer to our full plan details page.
PHP (HMO C-SNP) is a HMO C-SNP plan offered by AIDS Healthcare Foundation available for enrollment in 2025 to people living in Los Angeles County, California. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that PHP (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:
PHP (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.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PHP (HMO C-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 PHP (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
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 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 $5000.00 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
The PHP (HMO C-SNP) Medicare plan offers a Basic Alternative drug benefit with a $615.00 prescription drug deductible. After meeting this deductible, you enter the initial coverage phase where standard pharmacy costs include a 22% coinsurance for preferred generics and a 25% coinsurance for standard generics and preferred brands. Notably, there is no copay for tier four non-preferred drugs during this phase. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs. Additionally, if you qualify for the low-income subsidy, your Part D premium can be reduced to zero dollars. Be sure to check the plan's formulary to verify coverage for your specific medications.
Additional Benefits
The PHP (HMO C-SNP) plan offers robust healthcare coverage featuring affordable hospital, emergency, and preventive services. Inpatient hospital stays require an 80 dollar daily copay for days one through six, followed by no copay for days seven through 90. Emergency room visits and ambulance transport both carry a 50 dollar copay with no coinsurance, while skilled nursing facility stays of up to 100 days are provided with no copay or coinsurance. This plan also includes strong supplemental benefits with no deductibles, including a 400 dollar annual vision allowance and dental coverage up to a 1,550 dollar yearly limit. Members benefit from a 2,500 dollar annual hearing aid allowance, a 550 dollar yearly limit for over-the-counter items, and 24 round trips for health-related transportation. Additional perks include up to 5,000 dollars annually for home safety modifications and post-hospitalization meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by PHP (HMO C-SNP), requiring prior authorization and a doctor referral for both acute and psychiatric stays. Covered stays have an $80 daily copay for days 1 to 6, no copay for days 7 to 90, and no coinsurance, though additional days, non-Medicare-covered stays, and upgrades for acute care are not covered.
Outpatient Services See details
PHP (HMO C-SNP) covers outpatient hospital, observation, ambulatory surgical center, and blood services with no deductible, though specific copay and coinsurance details are not provided. Some outpatient substance abuse services are covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered by PHP (HMO C-SNP), requiring both prior authorization and a doctor referral for services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by PHP (HMO C-SNP), with ground and air ambulance services requiring a $50 copay and no coinsurance. The transportation benefit is partially covered, offering up to 24 round trips per year to plan-approved health-related locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are partially covered by PHP (HMO C-SNP), featuring a $50 copay and no coinsurance for emergency services, and no copay or coinsurance for urgently needed services. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Primary care benefits are partially covered by PHP (HMO C-SNP), including doctor visits, therapies, and telehealth, though podiatry and routine chiropractic care are not covered. Some mental health and psychiatric services are covered, but their individual and group sessions are not covered, and specific copay or coinsurance costs are not provided.
Preventive Services See details
Preventive services are partially covered by PHP (HMO C-SNP), featuring Medicare-covered zero-dollar preventive services with no copay or coinsurance when a doctor referral is obtained. While benefits like health education and up to $5,000 annually for home safety modifications are included, several sub-services—such as annual physical exams, weight management programs, and alternative therapies—are not covered.
Hearing Services See details
Hearing services are covered by PHP (HMO C-SNP), including annual routine exams and fitting evaluations with no deductible. Hearing aids are covered up to a $2,500 annual limit for both ears, though prescription hearing aids are only partially covered since inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Vision services are partially covered by PHP (HMO C-SNP) with no deductible, though eyewear upgrades are not covered. The plan provides one routine eye exam per year and a $400 annual maximum allowance for contacts and eyeglasses, with no copays or coinsurance specified.
Dental Services See details
PHP (HMO C-SNP) partially covers dental services, which include unlimited oral exams, annual x-rays, cleanings, and comprehensive procedures up to a $1,550 yearly limit, though orthodontics is not covered. While specific copay and coinsurance amounts are not provided, prior authorization is required for Medicare-covered dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are partially covered by PHP (HMO C-SNP) and require prior authorization. While Medicare Part B insulin drugs are covered under this benefit, Medicare Part B chemotherapy and radiation drugs are not covered.
Dialysis Services See details
Dialysis services are covered by the PHP (HMO C-SNP) plan, but members must obtain prior authorization and a doctor referral. Specific copay and coinsurance costs for these dialysis services are not detailed in the plan's benefit summary.
Medical Equipment See details
PHP (HMO C-SNP) covers Durable Medical Equipment (DME) with prior authorization from preferred vendors, but some services are covered while prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by PHP (HMO C-SNP) with no copay and no coinsurance. Although some services are covered, diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Home health services are covered by PHP (HMO C-SNP), requiring both prior authorization and a doctor referral. Specific copay and coinsurance costs for these services are not detailed in the plan's information.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PHP (HMO C-SNP) plan, which includes cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
PHP (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance for days 1 through 100, though prior authorization and a doctor referral are required. Additional days beyond the Medicare-covered limit are not covered under this benefit.
Other Services See details
Other Services are partially covered by PHP (HMO C-SNP), which provides up to 24 acupuncture treatments yearly with a doctor referral and meal benefits after hospital stays or for chronic illness, but excludes Dual Eligible SNP services. Over-the-counter (OTC) items are also partially covered up to $550 annually, though nicotine replacement therapy and naloxone are not covered.
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