A non-government entity
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 Los Angeles County. 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 $490.00 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 $490 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $1 copay at preferred pharmacies. In the initial coverage phase, you'll pay these costs until your total drug costs reach $2,000. Once you reach this amount, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The VillageHealth (HMO-POS C-SNP) plan offers a variety of benefits with varying cost-sharing. Hospital stays and outpatient services, including ambulance, typically involve a 20% coinsurance. Dental services are covered with copays ranging from $0-$395 depending on the service, and vision services have a 20% coinsurance with a $200 annual limit for eyewear. This plan also includes coverage for primary care, preventive services, and home health services, with no copay. Additionally, the plan offers an over-the-counter item benefit up to $60 per month.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. The plan requires prior authorization and the cost sharing is the Medicare-defined cost share for tier 1.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Outpatient Blood Services include an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the VillageHealth (HMO-POS C-SNP) plan. The plan covers partial hospitalization, but does not specify cost-sharing details such as copay or coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the VillageHealth (HMO-POS C-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location are covered for up to 40 one-way trips per year with no copay.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the VillageHealth (HMO-POS C-SNP) plan with no copay; however, there is a 20% coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The VillageHealth (HMO-POS C-SNP) plan covers 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. Chiropractic Services are covered with 20% coinsurance, and Physical Therapy and Speech-Language Pathology Services have 20% coinsurance, while Physician Specialist Services and Additional Telehealth Benefits have a coinsurance between 0% and 20%.
Preventive Services See details
Preventive Services are covered by the VillageHealth (HMO-POS C-SNP) plan, including Annual Physical Exams, Medicare-covered preventive services, and additional preventive services. Additional services such as Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, and others are not covered. Kidney Disease Education Services have a 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, and others are covered.
Hearing Services See details
Hearing Services are partially covered by the VillageHealth (HMO-POS C-SNP) plan. Hearing exams have a coinsurance of at most 20%, but routine hearing exams and fitting/evaluation for hearing aids are not covered; prescription hearing aids and OTC hearing aids are also not covered.
Vision Services See details
The VillageHealth (HMO-POS C-SNP) plan covers vision services including eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are limited to 1 per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, has a 20% coinsurance, and a combined maximum benefit of $200 per year. Upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and Other Dental Services, which covers Oral Exams, Dental X-Rays (limited to 2 per year), Other Diagnostic Dental Services, Prophylaxis (Cleaning) (limited to 2 per year), Fluoride Treatment (limited to 2 per year), Other Preventive Dental Services, Restorative Services (copay $0-$350), Adjunctive General Services (copay $0-$125), Endodontics (copay $0-$395), Periodontics (copay $0-$250), Prosthodontics, removable (copay $0-$350), Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed (copay $0-$350), and Oral and Maxillofacial Surgery (copay $0-$350); however, 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 with 0-20% coinsurance, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the VillageHealth (HMO-POS C-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The VillageHealth (HMO-POS C-SNP) plan covers Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance between 0% and 20%; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the VillageHealth (HMO-POS C-SNP) plan, with no copay for all services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the VillageHealth (HMO-POS C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the VillageHealth (HMO-POS C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not cover additional days beyond Medicare-covered for SNF, or non-Medicare-covered stays for SNF.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $60.00 per month, and a meal benefit that requires prior authorization and a doctor referral. Acupuncture and several other services are not covered.
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