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Elite Core HMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Elite Core HMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Elite Core HMO (HMO) in 2026, please refer to our full plan details page.
Elite Core 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 Core 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 Core 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 Core 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 $1499.00 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
Elite Core HMO (HMO) offers an enhanced alternative prescription drug plan featuring no prescription drug deductible. During the initial coverage phase, you will pay a $7 copay for Tier 1 preferred generics and a $47 copay for Tier 2 standard generics at standard pharmacies. Higher-tier medications require a 25% coinsurance for Tier 3 preferred brands, a 33% coinsurance for Tier 4 non-preferred drugs, and no copay for Tier 5 specialty tier drugs. These initial coverage costs apply for a 30-day supply until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs hit this $2,100.00 threshold, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, if you qualify for the low-income subsidy (LIS), your Part D costs are reduced to $0.
Additional Benefits
The Elite Core HMO (HMO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring a $100 daily copay for the first five days of inpatient hospital stays and no copay for days 6 through 90. Outpatient hospital services require a $125 copay, while emergency room visits carry a $150 copay that is waived upon admission. Additionally, members pay no copay for urgently needed care, routine preventive services, and home health care. For extra wellness support, the plan provides routine vision exams with a $300 annual eyewear allowance and routine hearing exams with no copay. Dental care is highly accessible with no coinsurance and copays ranging from no copay up to $98, complemented by a $90 quarterly over-the-counter allowance. While many essential services are covered, certain specialized treatments, durable medical equipment, and dialysis require up to a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Elite Core HMO (HMO), with covered acute and psychiatric stays requiring a $100 copay per day for days 1 to 5, no copay for days 6 to 90, and no coinsurance. Prior authorization and referrals are required, but upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered by Elite Core HMO (HMO), though outpatient substance abuse services are only partially covered because group sessions are not covered. Covered outpatient hospital and observation services require a $125 copay with no coinsurance, while individual outpatient substance abuse sessions have a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Elite Core HMO (HMO), but require prior authorization and a doctor referral. Specific copay and coinsurance amounts are not specified in the plan details.
Ambulance and Transportation Services See details
Elite Core HMO (HMO) provides partial coverage for ambulance and transportation services, featuring ground ambulance services with a $225 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation benefits are also partially covered, offering 10 one-way bus or subway trips per year to any health-related location with no copay and no coinsurance, while transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Elite Core HMO (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services feature no copay or coinsurance, while worldwide emergency services are covered up to $20,000 with no coinsurance and copays ranging from $90 to $200.
Primary Care See details
Primary care benefits are partially covered by Elite Core HMO (HMO), as group sessions for mental health and psychiatric services are not covered. Covered individual mental health and psychiatric sessions require a $25 copay, while opioid treatment program services require a 20% coinsurance.
Preventive Services See details
Elite Core HMO (HMO) partially covers preventive services, offering Medicare-covered zero-dollar services with no copay and no coinsurance, as well as annual exams, health education, therapeutic massage, and fitness benefits. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety devices, or counseling.
Hearing Services See details
Hearing services are partially covered by the Elite Core HMO (HMO) plan, with no deductible or coinsurance required for covered services. Routine hearing exams and fitting evaluations have no copay, while covered prescription hearing aids require a copay of $399.00 to $949.00, but OTC hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered by Elite Core HMO (HMO), which includes one routine eye exam per year and a $300 annual maximum benefit for eyewear with no deductibles. Covered eyewear options include contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by Elite Core HMO (HMO), featuring no coinsurance and copays ranging from no copay up to $98. Covered services include preventive care, periodontics, and oral surgery, while endodontics, implant services, maxillofacial prosthetics, prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Elite Core HMO (HMO) covers Home Infusion bundled Services with prior authorization required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Elite Core HMO (HMO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive this covered benefit.
Medical Equipment See details
Medical equipment benefits are covered by Elite Core HMO (HMO) with no copays, though prior authorization is required. Members will pay between no coinsurance and 20% coinsurance for durable medical equipment (DME) and diabetic supplies, and a flat 20% coinsurance for prosthetics and medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Elite Core HMO (HMO), though some diagnostic services are covered while diagnostic procedures, tests, and lab services are not covered. Radiological services are partially covered, excluding therapeutic radiological services, and feature a copay plus 20% coinsurance for diagnostic radiological services, and a $50 copay with no coinsurance for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered under the Elite Core HMO (HMO) plan, though a doctor referral is required to receive care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Elite Core HMO (HMO) plan, meaning there is no coverage for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services. Since these services are not covered, members do not have copay or coinsurance benefits and are responsible for the full cost of these therapies.
Skilled Nursing Facility (SNF) See details
Elite Core HMO (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and a doctor referral. Covered stays feature no coinsurance, with no copay for days 1 to 20 and a $100 daily copay for days 21 to 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Elite Core HMO (HMO) partially covers other services, offering a meal benefit for chronic illness with prior authorization and a doctor referral, up to 12 acupuncture treatments per year, and a 90 dollar quarterly over-the-counter allowance. However, dual eligible SNP services, nicotine replacement therapy, naloxone, and some over-the-counter drugs are not covered.
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