PHP (HMO C-SNP)
AHF · HMO C-SNP · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $5,000
- Drug deductible
- $700
- Tied for highest here
- Medicare star rating
- No rating yet
This is a special needs plan. Only some people can join: Chronic or Disabling Condition.
In plain English
Compared with the 40 other plans in Los Angeles County that the same person could join.
What stands out
- No monthly premium
- $90 for the emergency room, lower than most plans here
- Dental, vision and hearing extras included
Watch out for
- $400 for a 5-day hospital stay, higher than most plans here
- $700 drug deductible, tied for highest here
- Dental: plan pays up to $1,550 a year, less than most plans here
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$0$0 in premiums + $0 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$540$0 in premiums + $540 for careHigher than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0Referral neededPlan approval may be needed
- Urgent care$0
- Emergency room$90Lower than most plans here
- Hospital stay$80 a day for days 1 to 6, then $0 for days 7 to 90Higher than most plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$0Referral neededPlan approval may be needed
- Outpatient hospital care$0
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$0Referral neededPlan approval may be needed
- Ground ambulance$50Tied for lowest herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 40 other plans in Los Angeles County that the same person could join. Read the plan’s 2027 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1GenericAfter the deductible | 15% of the price |
| 2Preferred BrandAfter the deductible | 25% of the price |
| 3Non-Preferred BrandAfter the deductible | 25% of the price |
| 4Specialty TierAfter the deductible | 25% of the price |
| 5Select Care Drugs | $0 |
For a 1-month supply. The $700 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2027, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay $0.Plan pays up to $1,550 a year.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $400 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.Hearing aids: plan pays up to $2,500 a year, both ears.
- Over-the-counter items IncludedUp to $550 a year for things like vitamins, pain relief and bandages.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included24 round rides to medical visits a year.
What changed from 2026
- Drug deductible2026$6152027$700
- Emergency room2026$502027$90
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take PHP (HMO C-SNP), plan number H5852-001, for 2027?”