Plan ID: H5496-009

What You Need to Know:

  • Imperial Traditional Plus (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $32, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $445 (Tier 1 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $2,999 per year (in-network).
  • Imperial Traditional Plus (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $445 (Tier 1 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $32.

$32

Monthly Premium

Medicare Plan Features
Monthly Premium: $31.50
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$31.50 $0 $31.50 $0 $31.50 $445.0 1.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H5496-012
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $2,999
Annual Deductible: $445 (Tier 1 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Yolo, California: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members New plan - No summary rating as of yet. New plan - not yet rated. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,401 drugs
Number of Members Enrolled in this Plan in Yolo, California: NULL
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $31.50 $0.00 $31.50
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$0.00 $23.60 $23.60 $15.80 $15.80 $7.90 $7.90
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
761 0% 1089 25% 324 25% 604 25% 623 25%

Other Medicare Advantage Plans in Yolo, California

Plan Name Type Premium MOOP Rx Deduct. Rating
Health Net Healthy Heart (HMO) (2023)Local HMO$5,000$0
4
Sutter Advantage (HMO) (2023)Local HMO$4,900$0
5
My Choice (PPO) (2023)Local PPO$4,200$0
New plan - not yet rated.
UnitedHealthcare Medicare Advantage Assure (HMO) (2023)Local HMO$7,550$445
4
Western Health Advantage MyCare (HMO) (2023)Local HMO$7,000$0
New plan - not yet rated.
Imperial Traditional (HMO) (2023)Local HMO$2,999$0
New plan - not yet rated.
Aetna Medicare Elite Plan (PPO) (2023)Local PPO$7,550$0
5
Anthem MediBlue Plus (HMO) (2023)Local HMO$7,550$0
5
AARP Medicare Advantage SecureHorizons (HMO) (2023)Local HMO$4,900$100
4
Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) (2023)Local HMO$5,400$0
5
Health Net Ruby Select (HMO) (2023)Local HMO$4,500$0
4
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) (2023)Local HMO$6,700$0
5
AARP Medicare Advantage SecureHorizons Focus (HMO) (2023)Local HMO$4,900$0
4
Western Health Advantage MyCare Plus (HMO) (2023)Local HMO$5,500$0
New plan - not yet rated.
Medicare Advantage Plans by Imperial Health Plan of California, Inc
Imperial Traditional (HMO) (2023)Local HMO$2,999$0
New plan - not yet rated.

Find Medicare Advantage Plans in California