Health Education
No copayMandatory · prior authorization required
IncludedCentral Health Classic Care Plan III (HMO)
Central Health Medicare Plan
HMOSanta Clara CountyIncludes Part DPlan year 2026
$0/momonthly premium
$2,999most you pay in-network per year
3overall CMS star rating
6,369members 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$2,999
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 1–6$195 per day
Days 7–90$0 per day
Inpatient psychiatric stay
Days 1–6$195 per day
Days 7–90$0 per day
Doctor visits
Primary care visit
$0
You pay nothing
Specialist visit
$25
Copay
Telehealth visit
$0–$25
Copay, depends on the service
Other health care professional
$0–$10
Copay, depends on the service
Chiropractic care (Medicare-covered)
$0
You pay nothing
Routine chiropractic care
$0
You pay nothing
Podiatry (Medicare-covered)
$25
Copay
Emergency and urgent care
Emergency room visit
$150
Copay
Urgent care visit
$0
You pay nothing
Emergency care outside the U.S.
$150
Copay
Up to $50,000
Urgent care outside the U.S.
$150
Copay
Emergency transportation outside the U.S.
$150
Copay
Mental health and substance use
Individual therapy session
$10
Copay
Group therapy session
$10
Copay
Opioid treatment program
$0
You pay nothing
Partial hospitalization program
$100
Copay
Referral required
Prior authorization required
Therapy and rehabilitation
Occupational therapy
$0
You pay nothing
Physical and speech therapy
$0
You pay nothing
Cardiac rehabilitation
$0
You pay nothing
Intensive cardiac rehabilitation
$10
Copay
Pulmonary rehabilitation
$10
Copay
Supervised exercise therapy for peripheral artery disease
$10
Copay
Tests, labs and imaging
Lab services
$0
You pay nothing
Diagnostic tests
$0
You pay nothing
Diagnostic procedures
$0
You pay nothing
Diagnostic radiology (MRI, CT, PET)
$0–$200
Copay, depends on the service
Therapeutic radiology
20%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
$0–$250
Copay, depends on the service
Ambulatory surgical center
$0–$100
Copay, depends on the service
Observation services
$250
Copay
Blood services
$0
You pay nothing
Home health care
Home health visit
$0
You pay nothing
Ambulance
Ground ambulance
$0–$300
Copay, depends on the service
Air ambulance
20%
Coinsurance — your share of the bill
Medical equipment and supplies
Durable medical equipment
0–20%
Coinsurance, depends on the service
Medical supplies
0–20%
Coinsurance, depends on the service
Prosthetic devices
0–20%
Coinsurance, depends on the service
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
Part B insulin
0–20%
Coinsurance, depends on the service
Never more than $35 for a one-month supply
Preventive and wellness
Barium enema
$0
You pay nothing
Bathroom safety devices
$0
You pay nothing
Diabetes screening
$0
You pay nothing
Digital rectal exam
$0
You pay nothing
Electrocardiogram (EKG)
$0
You pay nothing
Enhanced disease management
$0
You pay nothing
Fitness (health club membership)
$0
You pay nothing
Glaucoma screening
$0
You pay nothing
Health education
$0
You pay nothing
In-home safety assessment
$0
You pay nothing
In-home support services
$0
You pay nothing
Nursing hotline
$0
You pay nothing
Personal emergency response system
$0
You pay nothing
Vision
Eye exam (Medicare-covered)
$0
You pay nothing
Routine eye exam
$0
You pay nothing
Eyewear after cataract surgery (Medicare-covered)
$0
You pay nothing
Eyewear allowance
Up to $200 per year
Allowance
Hearing
Hearing exam (Medicare-covered)
$0
You pay nothing
Routine hearing exam
$0
You pay nothing
Hearing aid fitting and evaluation
$0
You pay nothing
Prescription hearing aids
$575–$2,099
Copay, depends on the service
Over-the-counter hearing aids
$0
You pay nothing
Extra benefits
Over-the-counter items
$0
You pay nothing
Meals
$0–$5
Copay, depends on the service
Acupuncture
$0
You pay nothing
Extra benefits beyond Original Medicare
Supplemental benefits this plan filed with CMS, with the cap and period exactly as filed.
In-Home Safety Assessment
No copayMandatory · prior authorization required
IncludedPersonal Emergency Response System (PERS)
No copayMandatory · prior authorization required
IncludedIn-Home Support Services
No copayMandatory · prior authorization required
IncludedFitness Benefit
Physical Fitness
No copayMandatory · prior authorization required
IncludedEnhanced Disease Management
No copayMandatory · prior authorization required
IncludedRemote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Nursing Hotline
No copayMandatory · prior authorization required
IncludedHome and Bathroom Safety Devices and Modifications
No copay · up to $250 Every yearMandatory · prior authorization required
IncludedNot offered by this plan
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 CounselingTelemonitoring ServicesCounseling Services
Dental
No dental deductible.
Preventive
Oral exams$0–$17 copay, prior authorization
CleaningsNo copay, prior authorization
X-rays$0–$41 copay, prior authorization
Fluoride treatment$0–$13 copay, prior authorization
Other diagnostic services$0–$15 copay, prior authorization
Other preventive servicesNo copay, prior authorization
Comprehensive
Restorative (fillings)$0–$424 copay, prior authorization
Endodontics (root canals)No copay, prior authorization
Periodontics (gum treatment)No copay, prior authorization
Oral surgery$0–$237 copay, prior authorization
Fixed prosthodontics (crowns, bridges)$75–$295 copay, prior authorization
Removable prosthodontics (dentures)$0–$220 copay, prior authorization
Adjunctive general services$0–$166 copay, prior authorization
Medicare-covered dental services: $0 copay.
Prescription drugs (Part D)
$125 annual drug deductible · 6 formulary tiers · mail order available. Costs shown for a 30-day supply.
Before the deductible
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | — | No copay | — | — | Waived |
| 2. Generic | — | No copay | — | — | Waived |
| 6. Select Care Drugs | — | No copay | — | — | Waived |
Initial coverage
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | — | No copay | — | — | Waived |
| 2. Generic | — | No copay | — | — | Waived |
| 3. Preferred Brand | — | 15% coinsurance | — | — | Applies |
| 4. Non-Preferred Drug | — | 30% coinsurance | — | — | Applies |
| 5. Specialty Tier specialty | — | 31% coinsurance | — | — | Applies |
| 6. Select Care Drugs | — | No copay | — | — | 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 | — | Applies |
| 4. Non-Preferred Drug | No copay | No copay | No copay | — | Applies |
| 5. Specialty Tier specialty | No copay | No copay | No copay | — | Applies |
| 6. Select Care Drugs | 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 out of 5Overall rating
3 out of 5Health services (Part C)
3.5 out of 5Drug plan (Part D)
Staying healthy: screenings, tests and vaccines
3- Annual flu vaccine5
- Breast cancer screening3
- Colorectal cancer screening3
- Monitoring physical activity4
- Improving or maintaining mental health2
- Improving or maintaining physical health3
Managing chronic (long-term) conditions
3- Readmissions2
- Kidney health4
- Blood pressure3
- Reducing falls3
- Statin therapy3
- Pain assessment3
- Bladder control1
- Medication review4
- Diabetes eye exam4
- Transitions of care2
- Diabetes blood sugar3
- Osteoporosis management5
- Followup after emergency department visit2
- Medication reconciliation4
- Special needs plan SNP care management2
Member experience with the health plan
- Healthcare quality1
- Health plan rating1
- Getting needed care1
Member complaints and changes in the plan's performance
4- Complaints4
- Members leaving3
- Quality improvement4
Health plan customer service
4- Call center5
- Timely decisions4
- Appeals decisions3
Drug plan customer service
5- Call center foreign language interpreter and TTY availability5
Drug plan complaints and changes
4- Complaints4
- Members leaving3
- Quality improvement5
Member experience with the drug plan
- Drug plan rating3
Drug safety and accuracy of drug pricing
3- Price accuracy5
- Statin diabetes4
- Medication therapy management comprehensive medication review completion2
- Medication adherence for diabetes medications3
- Medication adherence for hypertension RAS antagonists s2
- Medication adherence for cholesterol statins2
Service area and network
Sold in 7 California counties.
AlamedaContra CostaFresnoSan FranciscoSan JoaquinSanta ClaraSolano
Doctor directory
36,460 providers are named in Central Health Medicare Plan’s directory for this plan, dated Aug 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, 2006
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.