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IEHP DualChoice (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for IEHP DualChoice (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on IEHP DualChoice (HMO D-SNP) in 2025, please refer to our full plan details page.
IEHP DualChoice (HMO D-SNP) is a HMO D-SNP plan offered by INLAND EMPIRE HEALTH PLAN 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 IEHP DualChoice (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
IEHP DualChoice (HMO D-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 IEHP DualChoice (HMO D-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 IEHP DualChoice (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.70. 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 $590.00 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 Maximum Out-Of-Pocket cost of $9200.00 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 IEHP DualChoice (HMO D-SNP) plan has a deductible of $590.00. If you qualify for the low-income subsidy, the monthly premium for Part D is $29.70. After the deductible, you pay costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The IEHP DualChoice (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services are covered with a 20% coinsurance, including outpatient services, partial hospitalization, ambulance services, and most primary care services. Diagnostic, radiological, and medical equipment services also have a 20% coinsurance. Preventive services, including Medicare-covered services, are available with a 20% coinsurance for some screenings, while other services are not covered. Home health services are covered with no copay or coinsurance. This plan also offers limited dental, vision, and hearing coverage, as well as an over-the-counter benefit, with some services requiring prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the specific cost-sharing details like copay and deductible are not provided. Additional days, upgrades, and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, all with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the IEHP DualChoice (HMO D-SNP) plan, but requires prior authorization and a doctor's referral. You will be responsible for a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by IEHP DualChoice (HMO D-SNP). Ground and Air Ambulance Services have a 20% coinsurance, with no copay, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services are covered with a 20% coinsurance, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The IEHP DualChoice (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance, while Chiropractic Services and Opioid Treatment Program Services also have a 20% coinsurance. Additional Telehealth Benefits have a coinsurance between 0% and 20%. Occupational Therapy Services have a 20% coinsurance. Routine Chiropractic Care is not covered, and Podiatry Services are also not covered.
Preventive Services See details
IEHP DualChoice (HMO D-SNP) covers preventive services, including Medicare-covered zero-dollar preventive services. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance. Other services, such as annual physical exams, health education, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by the IEHP DualChoice (HMO D-SNP) plan. Hearing exams are covered with at most 20% coinsurance, but routine hearing exams and fitting/evaluation for hearing aids are not covered. Prescription and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, with a 20% coinsurance for eye exams and eyewear. Routine eye exams are limited to one per year, and contact lenses, eyeglass lenses and eyeglass frames are covered. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are partially covered under the IEHP DualChoice (HMO D-SNP) plan. Medicare Dental Services require prior authorization and a doctor referral, with a 20% coinsurance, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the IEHP DualChoice (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies, with a 20% coinsurance for Medicare-covered items, as well as Diabetic Equipment including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, each with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. For Diagnostic Procedures/Tests, the coinsurance is at most 20%, and for Lab Services, there is no coinsurance. For Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, the coinsurance is at most 20%.
Home Health Services See details
Home Health Services are covered by the IEHP DualChoice (HMO D-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 covered by the IEHP DualChoice (HMO D-SNP) plan, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization and a doctor referral are required for SNF services, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $40.00 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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