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 2026, 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 2026 to people living in Los Angeles County. The overall rating for this plan is not yet available for 2026.
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.
Below are a few key facts and commonly-asked questions about VillageHealth (HMO-POS C-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
For VillageHealth (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 $9250.00 (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 $9250.00 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.
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
The VillageHealth (HMO-POS C-SNP) Medicare plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $490.00. After meeting the deductible, Tier 1 preferred generic drugs require a $1.00 copay at preferred pharmacies or a $6.00 copay at standard pharmacies. For Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance regardless of the pharmacy type. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, beneficiaries who qualify for the Low-Income Subsidy (LIS) may have their Part D premium reduced to $12.00.
The VillageHealth (HMO-POS C-SNP) plan features a cost-sharing structure that relies heavily on a twenty percent coinsurance and no copay for most outpatient, diagnostic, dialysis, and emergency services. Inpatient hospital stays and skilled nursing facility care are partially covered, with your out-of-pocket costs determined by Original Medicare-defined copays and coinsurance. Additionally, primary care visits require no copay, though a twenty percent coinsurance applies to physical, occupational, and speech therapies. This plan also includes key supplemental benefits like dental coverage up to a two thousand dollar limit, a two hundred dollar annual vision allowance, and up to forty one-way transportation trips per year. While essential medical equipment and home infusion services are covered with no copay and up to twenty percent coinsurance, please note that routine hearing aids, diabetic supplies, and cardiac rehabilitation are not covered. Eligible members can also receive home health care and post-hospitalization meal benefits to assist with recovery.
VillageHealth (HMO-POS C-SNP) partially covers inpatient acute and psychiatric hospital services, with copays and coinsurance determined by Original Medicare-defined cost-sharing. Prior authorization is required, and the plan does not cover additional days, non-Medicare-covered stays, or upgrades for acute care.
VillageHealth (HMO-POS C-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services, with no copay and a 20% coinsurance. Outpatient blood services are also covered with no deductible.
Partial hospitalization benefits are covered under the VillageHealth (HMO-POS C-SNP) plan, although specific copayment and coinsurance cost details are not provided in the plan summary. Please contact the provider directly to determine your exact out-of-pocket costs for these services.
Ambulance and transportation services are covered by VillageHealth (HMO-POS C-SNP), featuring no copay and a 20% coinsurance for both ground and air ambulance services. Transportation benefits are partially covered, offering up to 40 one-way trips per year to plan-approved health-related locations with prior authorization, while transportation to any health-related location is not covered.
Emergency services are partially covered by VillageHealth (HMO-POS C-SNP), featuring a 20% coinsurance (waived if admitted to the hospital) and no copay 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 benefits are covered by VillageHealth (HMO-POS C-SNP) with no copays, but a 20% coinsurance applies to occupational therapy, physical and speech therapy, and opioid treatment. Podiatry is not covered, chiropractic services are partially covered with routine care excluded, and some mental health and psychiatric services are covered, though individual and group sessions are not.
Preventive Services are covered by VillageHealth (HMO-POS C-SNP) with no copay for zero-dollar services and a 20% coinsurance with no copay for kidney disease education. Additional services are partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, smoking cessation, home safety modifications, and counseling.
VillageHealth (HMO-POS C-SNP) covers some hearing services, though routine hearing exams, fitting and evaluations, prescription hearing aids, and OTC hearing aids are not covered. Covered hearing exams have a 20% coinsurance and no copay, with no deductible.
VillageHealth (HMO-POS C-SNP) partially covers vision services, which include one routine eye exam and select eyewear per year with a 20% coinsurance and no copay, up to a $200 annual limit. Eyewear upgrades are not covered under this plan.
VillageHealth (HMO-POS C-SNP) partially covers dental services, as the specific orthodontics sub-service is not covered. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive services are subject to a $2,000 annual maximum for orthodontic services.
VillageHealth (HMO-POS C-SNP) covers Home Infusion bundled services with prior authorization, featuring no copay and between no coinsurance and 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are also covered under this benefit for a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services are covered by VillageHealth (HMO-POS C-SNP) with 20% coinsurance and no copay.
Medical equipment is partially covered by VillageHealth (HMO-POS C-SNP) with no copay and no coinsurance to 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies. Diabetic supplies and diabetic therapeutic shoes/inserts are not covered under this benefit.
VillageHealth (HMO-POS C-SNP) partially covers diagnostic and radiological services, though lab services are not covered. Covered services, including diagnostic procedures, therapeutic and diagnostic radiological services, and outpatient X-rays, feature no copay and a 20% coinsurance.
Home Health Services are covered under the VillageHealth (HMO-POS C-SNP) plan, though specific copay and coinsurance costs are not detailed in the plan benefits. This coverage ensures eligible members can receive necessary medical care directly in their homes.
Cardiac Rehabilitation Services are not covered under the VillageHealth (HMO-POS C-SNP) plan, as all sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage.
VillageHealth (HMO-POS C-SNP) partially covers Skilled Nursing Facility (SNF) services, which require prior authorization but do not require a prior three-day inpatient hospital stay. Under this plan, you will pay Medicare-defined copays and coinsurance, though additional days beyond the Medicare-covered limit are not covered.
Other Services are partially covered by VillageHealth (HMO-POS C-SNP), which includes a meal benefit after surgery or hospitalization but excludes coverage for acupuncture, over-the-counter (OTC) items, and highly integrated dual eligible SNP services. The covered meal benefit requires prior authorization and a doctor referral, though specific copay and coinsurance information is not provided in the plan details.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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