Imperial Strong (HMO)
H5496 - 014 - 0
(3 / 5)
Imperial Strong (HMO) is a Medicare Advantage (Part C) Plan by Imperial Health Plan of California, Inc..
This page features plan details for 2024 Imperial Strong (HMO) H5496 – 014 – 0 available in Northern, Central and Southern California.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Imperial Strong (HMO) is offered in the following locations.
Plan Overview
Imperial Strong (HMO) offers the following coverage and cost-sharing.
| Insurer: | Imperial Health Plan of California, Inc. |
| Health Plan Deductible: | Coming soon |
| MOOP: | $8,850 In-network |
| Drugs Covered: | Yes |
Ready to sign up for Imperial Strong (HMO) ?
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Imperial Strong (HMO) qualifies for a monthly Medicare Give Back Benefit of $85.00.
| Premium Reduction: | $85.00 |
Premium Breakdown
Imperial Strong (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $174.70 | $0.00 | $0.00 | $85.00 | $89.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
Imperial Strong (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $545.00 |
| Initial Coverage Limit: | $5,030.00 |
| Catastrophic Coverage Limit: | $8,000.00 |
| Drug Benefit Type: | Defined Standard Benefit |
| Additional Gap Coverage: | |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
| Part D | LIS Full |
|---|---|
| $0.00 | $ |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
Initial Coverage Phase
After you pay your $545.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 25% |
60 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
90 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 25% | 25% |
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
30 Day
90 Day
30 Day
90 Day
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
Imperial Strong (HMO) also provides the following benefits.
| Coming soon |
| In-network | No |
| $8,850 In-network |
| No |
| In-network | No |
| 20% coinsurance per visit (Authorization is required.) (Referral is required.) |
| Primary | 20% coinsurance per visit (Not applicable.) (Not applicable.) |
| Specialist | 20% coinsurance per visit (Authorization is required.) (Referral is required.) |
| $0 copay (Authorization is not required.) (Referral is required.) |
| Emergency | 20% coinsurance per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | 20% coinsurance per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Lab services | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Diagnostic radiology services (e.g., MRI) | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Outpatient x-rays | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Hearing exam | $0 copay (Authorization is required.) (Referral is required.) |
| Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
| Hearing aids | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
| Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Diagnostic services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Restorative services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Endodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Periodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Extractions | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Physical therapy and speech and language therapy visit | 20% coinsurance (Authorization is required.) (Referral is required.) |
| 20% coinsurance (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Foot exams and treatment | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Diabetes supplies | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | $0 copay (Authorization is required.) (Not applicable.) |
| Coming soon (Authorization is required.) (Referral is required.) |
| Inpatient hospital – psychiatric | Coming soon (Authorization is required.) (Referral is required.) |
| Outpatient group therapy visit with a psychiatrist | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Outpatient individual therapy visit with a psychiatrist | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Outpatient group therapy visit | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Outpatient individual therapy visit | 20% coinsurance (Authorization is required.) (Referral is required.) |
| Coming soon (Authorization is required.) (Referral is required.) |
Ready to sign up for Imperial Strong (HMO) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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