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Elite Signature HMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Elite Signature HMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Elite Signature HMO (HMO) in 2026, please refer to our full plan details page.
Elite Signature HMO (HMO) is a HMO plan offered by Elite Health Systems, Inc. available for enrollment in 2026 to people living in Los Angeles, Riverside, San Bernardino. The overall rating for this plan is not yet available for 2026.
It's important to know that Elite Signature HMO (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Elite Signature HMO (HMO).
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 Elite Signature HMO (HMO), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $699.00 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 Elite Signature HMO (HMO) offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, members pay no copay for Tier 1 preferred generic drugs and a $35 copay for Tier 2 standard generic drugs at standard pharmacies. Tier 3 preferred brand drugs require a $98 copay, while Tier 4 non-preferred drugs carry a 33% coinsurance. There is also no copay for Tier 5 specialty drugs at standard pharmacies. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, qualified individuals who receive Extra Help can reduce their Part D premium to $0.
Additional Benefits
The Elite Signature HMO (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, including inpatient hospital stays at a $75 daily copay for the first five days and no copay for days 6 through 90. Emergency room visits carry a $95 copay that is waived if you are admitted, while urgent care visits have no copay. Additionally, ground ambulance services require a $100 copay, and up to 20 one-way transportation trips to health-related locations are provided with no copay. This plan also features valuable everyday health benefits, including routine dental care with copays up to $98 and annual vision and hearing exams with no copay. Beneficiaries receive a $250 annual allowance for eyewear and can purchase prescription hearing aids with copayments ranging from $399 to $949. Other perks include a $65 quarterly over-the-counter allowance, no copay for standard preventive services, and acupuncture visits for a $10 copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Elite Signature HMO (HMO) with a $75 daily copay for days 1 to 5, no copay for days 6 to 90, and no coinsurance. Prior authorization is required, and the plan does not cover additional days, non-Medicare-covered stays, or upgrades for acute or psychiatric care.
Outpatient Services See details
Elite Signature HMO (HMO) covers outpatient services, including outpatient hospital, observation, and ambulatory surgical services, though outpatient substance abuse services are only partially covered as group sessions are not covered. Individual outpatient substance abuse sessions require a $25 copay with no coinsurance, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
Elite Signature HMO (HMO) covers partial hospitalization benefits, which require prior authorization and a doctor referral. Specific copay and coinsurance details for these services are not specified in the plan terms.
Ambulance and Transportation Services See details
Elite Signature HMO (HMO) covers ambulance and transportation services, with transportation being partially covered since plan-approved health-related locations are excluded. Ground ambulance services require a $100 copay and no coinsurance, air ambulance services require a 20% coinsurance and no copay, and up to 20 one-way trips to any health-related location are covered with no copay or coinsurance.
Emergency Services See details
Elite Signature HMO (HMO) covers emergency services with a $95 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services have no copay or coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $10,000 lifetime maximum with copays ranging from $50 to $100 and no coinsurance.
Primary Care See details
Elite Signature HMO (HMO) covers primary care, specialist, and therapy services, though mental health and psychiatric services are only partially covered since group sessions are not covered. Covered services feature a $10 copay for routine chiropractic and podiatry, a $25 copay for individual mental health and psychiatric sessions, and a 20% coinsurance for opioid treatment.
Preventive Services See details
Elite Signature HMO (HMO) partially covers preventive services, offering standard Medicare-covered preventive care and annual physical exams with no copay or coinsurance, and up to 12 therapeutic massage sessions for a $10 copay and no coinsurance. However, the plan does not cover in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety devices, or counseling services.
Hearing Services See details
Elite Signature HMO (HMO) partially covers hearing services, offering annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids (all types) are covered with a copay of $399 to $949 and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered by Elite Signature HMO (HMO) with no deductibles for exams or eyewear. The plan includes one routine eye exam per year and offers a $250 annual combined maximum benefit for eyewear, which covers contacts, upgrades, and one pair of eyeglasses.
Dental Services See details
Dental services are partially covered by Elite Signature HMO (HMO), featuring copays ranging from no copay up to $98 and no coinsurance for covered benefits. Sub-services that are not covered under this plan include endodontics, removable and fixed prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Elite Signature HMO (HMO) covers Home Infusion bundled Services with prior authorization, featuring a $35 copay and no coinsurance for Medicare Part B insulin. Other covered Part B chemotherapy, radiation, and miscellaneous drugs have no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered under the Elite Signature HMO (HMO) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Medical Equipment benefits are covered by Elite Signature HMO (HMO) with no copay, though prior authorization is required for these services. Patients will pay between no coinsurance and 20% coinsurance for durable medical equipment and diabetic supplies, and a flat 20% coinsurance for prosthetic devices and medical supplies.
Diagnostic and Radiological Services See details
Elite Signature HMO (HMO) covers diagnostic and radiological services with no copay and no coinsurance, though in practice, some services are covered but diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered under the Elite Signature HMO (HMO) plan, requiring a doctor referral for services to be approved. While the benefit is covered, specific copay and coinsurance details are not specified in the plan summary.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Elite Signature HMO (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Elite Signature HMO (HMO), requiring prior authorization and a doctor referral. There is no coinsurance for this benefit, featuring no copay for days 1 through 20 and a $50 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Elite Signature HMO (HMO), featuring acupuncture with a $10 copay and no coinsurance for up to 12 annual treatments, a chronic illness meal benefit, and a $65 quarterly over-the-counter allowance. Highly integrated Dual Eligible SNPs, nicotine replacement therapy, and naloxone are not covered.
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