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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 2025, 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 3.5 out of 5 stars in 2025.
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 $580.00 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) plan has an enhanced alternative drug benefit. The plan has a deductible of $580. After the deductible is met, you will pay coinsurance or a copay for your prescriptions depending on the drug tier. In the initial coverage phase, you will pay 15% or 25% coinsurance for generic and brand name drugs at standard pharmacies. For non-preferred drugs, there is no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The PHP (HMO C-SNP) plan offers a wide range of benefits, including coverage for inpatient hospital stays with a $100 copay for days 1-6, and no copay for days 7-90, as well as outpatient services and emergency services with a $100 copay. The plan also covers a variety of services with no copay, such as preventive services, home health services, and durable medical equipment. This plan provides coverage for hearing exams, routine hearing exams, and hearing aids up to $2,500 per year, vision services including routine eye exams and eyewear with a combined maximum benefit of $400 per year, and dental services including oral exams, dental x-rays, and more, and orthodontic services up to a maximum of $1200 per year. Additionally, the plan includes coverage for ambulance and transportation services, home infusion, dialysis, and skilled nursing facility stays with no copay for the first 100 days, as well as other services such as acupuncture and over-the-counter items up to $550 per year.
Inpatient Hospital See details
Inpatient Hospital coverage under the PHP (HMO C-SNP) plan requires prior authorization and a doctor referral, with a $100 copay for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the PHP (HMO C-SNP) plan, including all outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, and outpatient blood services. Outpatient Substance Abuse Services are partially covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the PHP (HMO C-SNP) plan, but requires prior authorization and a doctor referral. No information about the cost of services is provided.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PHP (HMO C-SNP) plan. Ground and air ambulance services each have a $150 copay. Transportation services to a plan-approved health-related location are covered, with 24 round trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the PHP (HMO C-SNP) plan with a $100 copay and no coinsurance. Urgently Needed Services are covered with no copay or coinsurance, but Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered by this plan. Chiropractic Services, requires a doctor referral, but routine chiropractic care is not covered. Mental Health Specialty Services and Psychiatric Services are covered, but individual and group sessions are not covered. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay and other services that require a doctor referral, and some additional preventive services are covered, but annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, wigs, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers, additional smoking cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered. This plan also covers home and bathroom safety devices and modifications, with a maximum plan benefit coverage amount of $5,000 every year.
Hearing Services See details
The PHP (HMO C-SNP) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). Prescription hearing aids are covered up to $2,500 per year, while inner ear, outer ear, and over-the-ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The PHP (HMO C-SNP) plan covers vision services including routine eye exams once per year, and eyewear with a combined maximum benefit of $400 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, but upgrades are not covered.
Dental Services See details
The PHP (HMO C-SNP) plan covers dental services, including oral exams, dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery. Orthodontic services are covered up to a maximum of $1200 per year, while orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the PHP (HMO C-SNP) plan, with prior authorization required. Insulin, including Medicare Part B Insulin Drugs, is covered. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the PHP (HMO C-SNP) plan, but require prior authorization and a doctor referral.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, all with no copay and no coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment is also covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The PHP (HMO C-SNP) plan covers diagnostic and radiological services, but does not cover any of the listed sub-services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, or outpatient X-Ray services. There is no copay for these services.
Home Health Services See details
Home Health Services are covered by the PHP (HMO C-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PHP (HMO C-SNP) plan. Specifically, 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 PHP (HMO C-SNP) plan, with no copay for days 1-100, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
The PHP (HMO C-SNP) plan covers acupuncture with a limit of 24 treatments per year, and requires a doctor's referral. Over-the-counter (OTC) items are covered up to $550 per year, and meal benefits are covered with prior authorization. Some other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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