2020 Medicare Advantage Plan Services for
Central Health Medicare Plan (HMO)

Central Health Medicare Plan (HMO) H5649-001 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Central Health Medicare Plan available to residents in California. This plan includes additional Medicare prescription drug (Part-D) coverage. The Central Health Medicare Plan (HMO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $2,995 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $2,995 out of pocket. This can be a extremely nice safety net.

Central Health Medicare Plan (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Central Health Medicare Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Central Health Medicare Plan (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Central Health Medicare Plan and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Central Health Medicare Plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

2020 Central Health Medicare Plan Medicare Advantage Plan Details

Part-C Premium

Central Health Medicare Plan plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

Central Health Medicare Plan (HMO) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Central Health Medicare Plan plan offers a $0.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Central Health Medicare Plan above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Central Health Medicare Plan (HMO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.

Gap Coverage

In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Central Health Medicare Plan plan does offer additional coverage through the gap.

Central Health Medicare Plan Drug Coverage and Formulary

A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 Central Health Medicare Plan (HMO) H5649-001 Formulary here.

Drug Tier	Copay Preferred	Copay Nonpreferred
1	NA	$0
2	NA	$0
3	NA	$35
4	NA	$75
5	NA	33%
6	NA	$10

*Initial Coverage Phase and 30 day supply

See the 2020 Central Health Medicare Plan Formulary

2019 Plan Services

(*2020 Plan services will be added when available)

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Health plan deductible

$0

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Emergency care/Urgent care

Emergency		$50 per visit (always covered)
Urgent care		$0 copay

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Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures		$0 copay
Lab services		$0 copay
Diagnostic radiology services (e.g., MRI)		$0 copay
Outpatient x-rays		$0 copay

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Hearing

Hearing exam		$0 copay
Fitting/evaluation		$0 copay
Hearing aids		$0 copay

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Preventive dental

Oral exam		$0 copay
Cleaning		$0 copay
Fluoride treatment		$0 copay
Dental x-ray(s)		$0 copay

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Comprehensive dental

Non-routine services		Not covered
Diagnostic services		$0 copay
Restorative services		$0-295
Endodontics		$0 copay
Periodontics		$0 copay
Extractions		$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services		$0-295

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Vision

Routine eye exam		$0 copay
Other		Not covered
Contact lenses		$0 copay
Eyeglasses (frames and lenses)		$0 copay
Eyeglass frames		$0 copay
Eyeglass lenses		$0 copay
Upgrades		$0 copay

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Mental health services

Inpatient hospital - psychiatric		$0 copay
Outpatient group therapy visit with a psychiatrist		$5
Outpatient individual therapy visit with a psychiatrist		$5
Outpatient group therapy visit		$5
Outpatient individual therapy visit		$5

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Skilled Nursing Facility

$0 per day for days 1 through 20 $75 per day for days 21 through 65 $0 per day for days 66

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Rehabilitation services

Occupational therapy visit		$0 copay
Physical therapy and speech and language therapy visit		$0 copay

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Ground ambulance

$100

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Other health plan deductibles?

	In-Network	No

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Transportation

$0 copay

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Foot care (podiatry services)

Foot exams and treatment		$0 copay
Routine foot care		Not covered

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Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)		0-20% per item
Prosthetics (e.g., braces, artificial limbs)		10-20% per item
Diabetes supplies		$0 copay

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Wellness programs (e.g., fitness, nursing hotline)

Covered

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Medicare Part B drugs

Chemotherapy		20%
Other Part B drugs		20%

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$3,400 In-network

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Optional supplemental benefits

No

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Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

	In-Network	No

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Inpatient hospital coverage

$0 copay

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Outpatient hospital coverage

$0 copay

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Doctor visits

Primary		$0 copay
Specialist		$0 copay

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Preventive care

$0 copay

Ratings for Central Health Medicare Plan (HMO) H5649

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Central Health Medicare Plan (HMO) Plans Performance

Health Plan Customer Service Rating for Central Health Medicare Plan (HMO)

Central Health Medicare Plan (HMO) Drug Plan Customer Service ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Coverage Area for Central Health Medicare Plan (HMO)

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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.