Imperial Traditional (HMO)

Health Insurance Company: Imperial Health Plan of California, Inc.

Medicare Advantage Plan Details

Imperial Health Plan of California, Inc.
$0 /mo
monthly premium
Imperial Traditional (HMO)
Additional Coverage
Overall Star Rating (2024)
  • Rx
  • Dental
  • Vision
  • Hearing
3
out of 5 stars

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$1349
Rx Drug Coverage
Yes
Rx Deductible
$0
Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$0 copay

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Transportation for non-emergency
Yes
Fitness Benefits
Yes
Worldwide emergency
Yes
Telehealth
Yes
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$0 copay
Periodic Exam Coverage
$0 copay

Emergency Room

$125 copay per visit (always covered)

Ambulance Coverage

$150 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: 0-10% coinsurance
Medicare-covered lab services: 0-10% coinsurance
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): $0 copay
Medicare-covered x-ray services: $0 copay

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: $200 copay per visit

Hospitalization Coverage

Inpatient hospital-acute:
$150 per day for days 1 through 5
$0 per day for days 6 through 90
Inpatient hospital psychiatric:
$150 per day for days 1 through 5
$0 per day for days 6 through 90

Rehabilitation Coverage

Occupational therapy services:
$10 copay
Physical therapy and speech and language therapy services:
20% coinsurance

Urgent Care Coverage

$0 copay

Skilled Nursing Facility (SNF)

$0 per day for days 1 through 20
$200 per day for days 21 through 100

Mental Health Coverage

Medicare-covered individual sessions: 20% coinsurance
Medicare-covered group sessions: 20% coinsurance

Dental, Vision, Hearing Benefits

Dental Services

Oral exams: $0 copay
Prophylaxis (cleaning): $0 copay
Dental x-rays: $0 copay

Vision Benefits

Eye exams:
Routine eye exams: $0 copay
Eyewear:
Contact Lenses: $0 copay
Eyeglasses: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: $0 copay
Hearing aids:
Hearing aids (all types): $0 copay

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$5.00 copay (30-day supply)
$12.00 copay (90-day supply)

Tier 3: Preferred Brand

$45.00 copay (30-day supply)
$110.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$90.00 copay (30-day supply)
$225.00 copay (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

More Additional Benefits

Annual physical exams
No
Chiropractic Coverage
No
Acupuncture
No
Massage Therapy
No
Health Education
No
Counseling Services
No
Support for Caregivers of Enrollees
No
Personal Emergency Response System (PERS)
No
In-home support services
Yes
Home and bathroom safety devices
No
Meals for short duration
Yes

Plan Links

Ready to Enroll Online?

Or call and get free advice from licensed insurance agents

TTY 711
Mon-Fri: 8am-9pm, Sat: 9am-8pm ET
No Obligation to Enroll

Looking for other plans in your area?

Where This Plan is Available

Additional Plan Info

Plan Year:
2024
Insurance Company Website:
Imperial Health Plan of California, Inc.

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Aspire Health Plan
  • Dean Health Plan
  • Devoted Health
  • GlobalHealth
  • Health Care Service Corporation
  • Cigna Healthcare
  • Humana
  • Medica Central Health Plan
  • Molina Healthcare
  • Mutual of Omaha
  • Premera Blue Cross
  • SCAN Health Plan
  • Scott and White Health Plan now part of Baylor Scott & White Health
  • UnitedHealthcareⓇ
  • Wellcare