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Central Health Classic Care Plan II (HMO)

H5649 - 028 - 0
2.5 out of 5 stars (2.5 / 5)

Central Health Classic Care Plan II (HMO) is a Medicare Advantage Plan by Central Health Medicare Plan.

This page features plan details for 2025 Central Health Classic Care Plan II (HMO) H5649 – 028 – 0 available in Select counties in CA.

Locations

Central Health Classic Care Plan II (HMO) is offered in the following locations.

Alameda County, California
California
Contra Costa County, California

Click to see more locations

Plan Overview

Central Health Classic Care Plan II (HMO) offers the following coverage and cost-sharing.

Insurer:Central Health Medicare Plan
Health Plan Deductible:$0
MOOP:$2,499 In-network
Drugs Covered:Yes

Ready to sign up for Central Health Classic Care Plan II (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Central Health Classic Care Plan II (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
$185.00 $0.00 $0.00 $ $
Please Note:
  • 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

Central Health Classic Care Plan II (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $100.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

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 DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $100.00 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 $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Central Health Classic Care Plan II (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00-300.00 Copay (Limits Apply, Authorization Required)
  • Endodontics
    • In-Network: No Coins – 25.00-720.00 Copay (Limits Apply, Authorization Required)
  • Implant Services
    • In-Network: No Coins – 45.00-2160.00 Copay (Limits Apply, Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – 0.00-380.00 Copay (Limits Apply, Authorization Required)
  • Periodontics
    • In-Network: No Coins – 0.00-780.00 Copay (Limits Apply, Authorization Required)
  • Prosthodontics, fixed
    • In-Network: No Coins – 0.00-840.00 Copay (Limits Apply, Authorization Required)
  • Prosthodontics, removable
    • In-Network: No Coins – 0.00-600.00 Copay (Limits Apply, Authorization Required)
  • Restorative Services
    • In-Network: No Coins – 25.00-400.00 Copay (Limits Apply, Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Fluoride Treatment
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay (Authorization Required, Referral Required)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – 0.00-6.00 Copay (Limits Apply, Authorization Required)
  • Other Preventive Dental Services
    • In-Network: No Coins – 0.00-20.00 Copay (Limits Apply, Authorization Required)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay (Authorization Required)

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • $0 copay (Authorization Required, Referral Required)
  • Lab services
    • $0 copay (Authorization Required, Referral Required)
  • Outpatient x-rays
    • $0 copay (Authorization Required, Referral Required)
  • Diagnostic radiology services (e.g., MRI)
    • $0-200 copay (Authorization Required, Referral Required)

Doctor visits

  • Primary
    • $0 copay
  • Specialist
    • $10 copay per visit (Authorization Required, Referral Required)

Emergency care/Urgent care

  • Emergency
    • $0-140 copay per visit (always covered)
  • Urgent care
    • $0 copay

Foot care (podiatry services)

  • Foot exams and treatment
    • $0 copay (Authorization Required, Referral Required)
  • Routine foot care
    • Not covered

Ground ambulance

    • $0-250 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • $0 copay (Limits Apply)
  • Hearing aids OTC
    • $0 copay
  • Medicare-Covered Hearing Exam
    • $0 copay
  • Hearing aids
    • $575-2,099 copay (Limits Apply, Authorization Required)

Inpatient hospital coverage

    • $150 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required, Referral Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $2,499 In-network

Medical equipment/supplies

  • Diabetes supplies
    • $0 copay (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 0-20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • 0-20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit
    • 20% coinsurance (Authorization Required, Referral Required)
  • Inpatient hospital – psychiatric
    • $150 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required, Referral Required)
  • Outpatient group therapy visit with a psychiatrist
    • 20% coinsurance (Authorization Required, Referral Required)
  • Outpatient individual therapy visit
    • $10 copay (Authorization Required, Referral Required)
  • Outpatient individual therapy visit with a psychiatrist
    • $10 copay (Authorization Required, Referral Required)

Optional supplemental benefits

    • Yes

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $0-250 copay per visit (Authorization Required, Referral Required)

Preventive care

    • $0 copay (Authorization Required, Referral Required)

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • $0 copay (Authorization Required, Referral Required)
  • Occupational therapy visit
    • $0 copay (Authorization Required, Referral Required)

Skilled Nursing Facility

    • Coming soon (Authorization Required, Referral Required)

Transportation

    • $0 copay (Limits Apply, Authorization Required, Referral Required)

Vision

  • Contact lenses
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Eyeglass frames
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Routine eye exam
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Other
    • Not covered
  • Eyeglass lenses
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Upgrades
    • $0 copay (Limits Apply, Authorization Required, Referral Required)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered (Authorization Required, Referral Required)

Optional Supplemental Dental

Comprehensive Dental

  • Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, Adjunctive General Services
    • Monthly Premium: $21.00
    • Max Coverage: $3000.00
    • Coverage Periodicity: Every year

Diagnostic and Preventive Dental

  • Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services
    • Monthly Premium: $21.00
    • Max Coverage: $3000.00
    • Coverage Periodicity: Every year

Ready to sign up for Central Health Classic Care Plan II (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on Central Health Classic Care Plan II (HMO)? See 2025 Central Health Classic Care Plan II (HMO) at MedicareAdvantageRX.com.

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Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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