In-Home Support Services
Cost not publishedMandatory
IncludedImperial Dynamic Plan (HMO)
Imperial Health Plan of California, Inc.
HMOSanta Clara CountyIncludes Part DPlan year 2026
$0/momonthly premiumplus $35/mo back on your Part B premium
$296most you pay in-network per year
3.5overall CMS star rating
21,625members enrolled, January 2026
Plan-level limits
Premium, deductibles, and the most you can pay out of pocket in a year.
In-network out-of-pocket maximum$296
Part B premium giveback, per month$35
Plan premium, per month$0
What a year on this plan would likely cost
What you pay for care
In-network costs for every service in this plan's CMS benefit filing. A copay is a fixed dollar amount; coinsurance is a percentage of the bill.
Hospital stays
Inpatient hospital stay
Days 1–90$0 per day
Inpatient psychiatric stay
Days 1–90$0 per day
Skilled nursing facility stay
Days 1–20$0 per day
Days 21–50$100 per day
Days 51–100$200 per day
Emergency and urgent care
Emergency room visit
$125
Copay
Emergency care outside the U.S.
Up to $100,000
Allowance
Mental health and substance use
Partial hospitalization program
20%
Coinsurance — your share of the bill
Tests, labs and imaging
Therapeutic radiology
20%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
$100
Copay
Ambulatory surgical center
$100
Copay
Observation services
$100
Copay
Ambulance
Ground ambulance
$150
Copay
Air ambulance
20%
Coinsurance — your share of the bill
Medical equipment and supplies
Durable medical equipment
20%
Coinsurance — your share of the bill
Prosthetic devices
20%
Coinsurance — your share of the bill
Dialysis
Dialysis
20%
Coinsurance — your share of the bill
Part B drugs
Part B drugs
0–20%
Coinsurance, depends on the service
Chemotherapy drugs
0–20%
Coinsurance, depends on the service
Vision
Eyewear allowance
Up to $500 per year
Allowance
Hearing
Prescription hearing aids
Up to $500 per year, both ears combined
Allowance
Hearing allowance
Up to $250 per year
Allowance
Extra benefits
Over-the-counter items
Up to $140 every three months
Allowance
Other plan benefit
Up to $105 per year
Allowance
Extra benefits beyond Original Medicare
Supplemental benefits this plan filed with CMS, with the cap and period exactly as filed.
Fitness Benefit
Activity Tracker; Physical Fitness
Cost not publishedMandatory
IncludedNot offered by this plan
Health EducationIn-Home Safety AssessmentPersonal Emergency Response System (PERS)Medical Nutrition Therapy (MNT)Post discharge In-Home Medication ReconciliationRe-admission PreventionWigs for Hair Loss Related to ChemotherapyWeight Management ProgramsAlternative TherapiesTherapeutic MassageAdult Day Health ServicesNutritional/Dietary BenefitHome-Based Palliative CareSupport for Caregivers of EnrolleesAdditional Sessions of Smoking and Tobacco Cessation CounselingEnhanced Disease ManagementTelemonitoring ServicesRemote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Home and Bathroom Safety Devices and ModificationsCounseling Services
Dental
$500 every year allowance. No dental deductible.
Preventive
Oral examsMandatory
CleaningsMandatory
X-raysMandatory
Fluoride treatmentMandatory
Comprehensive
Restorative (fillings)Mandatory
Endodontics (root canals)Mandatory
Periodontics (gum treatment)Mandatory
Oral surgeryMandatory
Fixed prosthodontics (crowns, bridges)Mandatory
Removable prosthodontics (dentures)Mandatory
Prescription drugs (Part D)
$0 annual drug deductible · 5 formulary tiers · mail order available. Costs shown for a 30-day supply.
Initial coverage
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | — | No copay | — | — | Waived |
| 2. Generic | — | $6 copay | — | — | Waived |
| 3. Preferred Brand | — | $45 copay | — | — | Waived |
| 4. Non-Preferred Drug | — | $90 copay | — | — | Waived |
| 5. Specialty Tier specialty | — | 33% coinsurance | — | — | Waived |
Catastrophic (after the out-of-pocket threshold)
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | No copay | No copay | — | Waived |
| 2. Generic | No copay | No copay | No copay | — | Waived |
| 3. Preferred Brand | No copay | No copay | No copay | — | Waived |
| 4. Non-Preferred Drug | No copay | No copay | No copay | — | Waived |
| 5. Specialty Tier specialty | No copay | No copay | No copay | — | Waived |
Out-of-pocket threshold for the catastrophic phase: $2,100.
Is my medicine on this plan’s list?
Pharmacies near you in this plan's network
From the plan's filed Part D pharmacy network, matched to geocoded pharmacy locations. Preferred pharmacies come first: they carry the lower copay column in the tier table above. The ZIP you enter stays in this browser.
CMS star ratings
Star ratings are set by CMS for the whole contract, so every plan under this contract shares them.
3.5 out of 5Overall rating
3.5 out of 5Health services (Part C)
3.5 out of 5Drug plan (Part D)
Staying healthy: screenings, tests and vaccines
3- Annual flu vaccine2
- Breast cancer screening5
- Colorectal cancer screening5
- Monitoring physical activity3
- Improving or maintaining mental health1
- Improving or maintaining physical health3
Managing chronic (long-term) conditions
5- Readmissions5
- Kidney health5
- Blood pressure5
- Reducing falls2
- Statin therapy5
- Pain assessment5
- Bladder control1
- Medication review5
- Diabetes eye exam5
- Transitions of care5
- Diabetes blood sugar5
- Followup after emergency department visit5
- Medication reconciliation5
- Special needs plan SNP care management5
Member experience with the health plan
2- Customer service1
- Healthcare quality2
- Health plan rating2
- Getting needed care1
Member complaints and changes in the plan's performance
3- Complaints2
- Members leaving3
- Quality improvement4
Health plan customer service
4- Call center3
- Timely decisions5
- Appeals decisions5
Drug plan customer service
3- Call center foreign language interpreter and TTY availability3
Drug plan complaints and changes
3- Complaints2
- Members leaving3
- Quality improvement3
Member experience with the drug plan
4- Drug plan rating4
- Prescription drugs3
Drug safety and accuracy of drug pricing
4- Price accuracy4
- Statin diabetes5
- Medication therapy management comprehensive medication review completion4
- Medication adherence for diabetes medications4
- Medication adherence for hypertension RAS antagonists s4
- Medication adherence for cholesterol statins4
Why members leave this contract
Service area and network
Sold in 50 California counties.
AlamedaAmadorButteContra CostaDel NorteEl DoradoFresnoGlennHumboldtImperialInyoKernKingsLos AngelesMaderaMarinMariposaMendocinoMercedModocMonoMontereyNapaNevadaOrangePlacerPlumasRiversideSacramentoSan BenitoSan BernardinoSan DiegoSan FranciscoSan JoaquinSan Luis ObispoSan MateoSanta BarbaraSanta ClaraSanta CruzShastaSiskiyouSolanoSonomaStanislausTehamaTulareTuolumneVenturaYoloYuba
Doctor directory
4,095 providers are named in Imperial Health Plan of California, Inc.’s directory for this plan, dated Sep 1, 2026.
A doctor named there is listed. A doctor missing from it is unknown, never out of network: carrier directories are partial and change monthly. Open the carrier directory
Contract with Medicare sinceJan 1, 2018
Medicare Advantage regionCalifornia
Ask about this plan
A question box grounded in this plan's filed benefits, drug list, and pharmacy network. It reads the same records shown on this page and says so when something is not filed.
Answers come from this plan’s filed benefits, drug list, and pharmacy network. They are not enrollment advice; the Evidence of Coverage is the final word.