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VillageHealth (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VillageHealth (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VillageHealth (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
VillageHealth (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by SCAN Group available for enrollment in 2025 to people living in Riverside and San Bernardino Counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that VillageHealth (HMO-POS C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
VillageHealth (HMO-POS 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 VillageHealth (HMO-POS 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 VillageHealth (HMO-POS 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 $370.00 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 combined Maximum Out-Of-Pocket cost of $9350.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9350.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 VillageHealth (HMO-POS C-SNP) plan has a $370 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, you'll pay a $2 copay at preferred pharmacies or a $7 copay at standard pharmacies. For standard generic and preferred brand drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The VillageHealth (HMO-POS C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying cost-sharing. You'll find no copay for ambulance services, and no copay for home health services, but some services like Outpatient Hospital Services, Observation Services, and Emergency Services have a 20% coinsurance. This plan also includes coverage for vision, dental, and hearing services, with specific copays, coinsurance, and annual maximums. Additionally, it offers coverage for home infusion, dialysis, medical equipment, and diagnostic services, all with associated cost-sharing. The plan also offers a monthly allowance for over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered by the VillageHealth (HMO-POS C-SNP) plan. You will have a copay for these services, and additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Individual and Group Sessions for Outpatient Substance Abuse have a coinsurance between 20% and 20%. Outpatient Blood Services have a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the VillageHealth (HMO-POS C-SNP) plan. There is no additional cost information provided.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by VillageHealth (HMO-POS C-SNP), with no copay for ambulance services, but a 20% coinsurance for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered for up to 50 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the VillageHealth (HMO-POS C-SNP) plan with a 20% coinsurance, though the coinsurance is waived if admitted to the hospital. Urgently Needed Services are covered with no copay and no coinsurance, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services are covered with no coinsurance. Chiropractic Services, Physician Specialist Services, and Other Health Care Professional have a 20% coinsurance, while Additional Telehealth Benefits have a coinsurance between 0% and 20%. Mental Health Specialty Services and Psychiatric Services do not cover individual and group sessions. Opioid Treatment Program Services have a 20% coinsurance. Podiatry Services and Routine Chiropractic Care are not covered.
Preventive Services See details
The VillageHealth (HMO-POS C-SNP) plan covers preventive services including an annual physical exam, and other preventive services. Kidney Disease Education Services are covered with 20% coinsurance. Other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing services are partially covered by the VillageHealth (HMO-POS C-SNP) plan, with hearing exams covered at a coinsurance of at most 20% and no deductible. However, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types), prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear, with a 20% coinsurance for eye exams and contact lenses. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, as well as oral exams, dental x-rays (2 per year), other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), and other preventive dental services. Restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are covered with copays ranging from $0 to $395. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the VillageHealth (HMO-POS C-SNP) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
The VillageHealth (HMO-POS C-SNP) plan covers Durable Medical Equipment (DME) with a coinsurance of 0% to 20% and requires authorization, but does not cover DME for use outside the home. Prosthetics/Medical Supplies - Non-Medicare benefits are covered with a coinsurance, while Prosthetic Devices are covered with a coinsurance of 0% to 20%. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The VillageHealth (HMO-POS C-SNP) plan covers diagnostic and radiological services, including outpatient diagnostic procedures and tests with a coinsurance of at most 20% and no copay. Lab services are not covered. Radiological services, including diagnostic, therapeutic, and outpatient X-ray services, are covered with a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered by the VillageHealth (HMO-POS C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the VillageHealth (HMO-POS C-SNP) plan, but all of the sub-services are not covered. There is coinsurance for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered and require prior authorization. The plan does not provide additional days beyond Medicare-covered SNF, and non-Medicare covered stays for SNF are not covered.
Other Services See details
The VillageHealth (HMO-POS C-SNP) plan's "Other Services" benefit covers Over-the-Counter (OTC) Items with a maximum benefit of $50.00 per month, and a meal benefit that requires prior authorization and a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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