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AHF PHP (C-SNP) Plan Details for Los Angeles County, CA

This page provides coverage and cost details for AHF’s H5852-001-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.

CMS 2025 Rating: ☆☆☆☆☆*

*CMS rated this AHF plan (H5852-001-0) 3.5 (Above Average) out of 5 stars.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The AHF logo is a registered trademark.[2] Its use by MedicareWire is strictly for editorial purposes. This is not a solicitation of insurance.

This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.

Individuals must meet all Chronic or Disabling Condition SNP qualification requirements to join this C-SNP plan.

AHF PHP Basic Plan Details

Plan ID
H5852-001-0
Plan Type
HMO C-SNP
Plan Year
2025
Premium
$0.00/mo
Plus your Medicare Part B premium.
Health Plan Deductible
$0.00
Out-of-Pocket Maximum
5,000.00 /yr (in-network)
Part B Reduction
$0.00/mo
Drug Plan Benefit
Enhanced
$580.00 deductible
Supplemental Benefits
Vision, Hearing
Availability
Los Angeles County, CA
Insured By
AHF
Summary of Benefits

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Health Plan Out-of-Pocket Costs

The following table is a summary of the most common out-of-pocket costs you will incur if you join this AHF plan:

Doctor's Office Visits

Primary
Not Covered
Specialist
Not Covered

Emergency, Urgent, and Inpatient Hospital Coverage

Emergency room care
$100 Copay
Urgent care
Not Covered
Ground ambulance
$150 Copay
Inpatient hospital care
$100.00 per day for days 1 through 6
$0.00 per day for days 7 and beyond
Skilled Nursing Facility
$0.00 per day for days 1 through 100

Foot Care

Foot Exams and Treatments (Medicare-covered)
Not Covered
Routine Foot Care
Not Covered

Chiropractic Care

Medicare-covered chiropractic
Not Covered
Routine chiropractic
Not Covered

Mental Health Services

Outpatient individual therapy
Not Covered
Outpatient group therapy
Not Covered
Inpatient psychiatric hospital care
$100.00 per day for days 1 through 6
$0.00 per day for days 7 and beyond

Rehabilitation Services

Physical therapy and speech and language therapy
Not Covered
Occupational therapy
Not Covered

Medical Equipment and Supplies

Diabetes supplies
Not Covered
Durable medical equipment
Not Covered
Prosthetics
Not Covered

Diagnostics, Lab Services, and Imaging

Diagnostic radiology services
Not Covered
Lab services
Not Covered
Outpatient x-rays
Not Covered
Diagnostic tests and procedures
Not Covered

Medicare Part B Drugs

Chemotherapy
Not Covered
Other Part B drugs (Medicare-covered)
Not Covered

Dental Services

Medicare Covered Preventive Dental
Not Covered
Oral exam
$0
Dental x-rays
$0
Cleaning
$0
Periodontics
Not Covered
Endodontics
Not Covered
Restorative Services
Not Covered

Hearing Aids and Services

Fitting/evaluation
Covered
Limits may apply
Hearing aids
Not Covered
Hearing exam
Covered
Limits may apply

Vision Services

Medicare-covered eye exam
Routine eye exam
Covered
Limits may apply
Eyewear benefits
None
If you qualify for Medicare Advantage but don't know where to begin, we have licensed insurance agents[1] at 1-855-728-0510 (TTY 711) who can answer your questions (Mon-Fri 5am-6pm, Sat 6am-5pm PT) and help you get enrolled. There's no obligation.

Prescription Drug Costs & Benefits

AHF PHP includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.

As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.

Prescription Drug Premium with Extra Help

Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.

Low Income Premium Subsidy: ${part_d_lips_amount}
Low Income Premium Subsidy CMS Pays: $0.00
Low Income Subsidy Premium: $0.00

If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.

Prescription Drug Deductible

The Medicare Part D annual deductible with this plan is $580.00. You must pay this amount at the pharmacy before AHF begins paying its share.

Prescription Drug Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, AHF PHP has out-of-pocket costs you must pay when you pick up your prescriptions.

Drug Tier Retail Mail Order
Generic15.00%N/A
Preferred Brand15.00%N/A
Non-Preferred Brand25.00%N/A
Specialty Tier25.00%N/A
Select Care Drugs*$0.00N/A
*The Part D deductible does not apply.

How to Qualify to Enroll in
AHF PHP

To be eligible to enroll in AHF PHP , you must meet these requirements:

  1. You are eligible for Medicare;
  2. You live in Los Angeles County (the plan’s service area); and
  3. You have been diagnosed with one or more severe or disabling chronic conditions.

A disabling chronic condition (disease) is one that lasts one or more years and requires ongoing medical attention and/or limits activities of daily living. They include:

  • Autoimmune disorders
  • End-stage renal disease
  • Cancer
  • Cardiovascular disorders
  • Hematologic disorders
  • HIV/AIDS
  • Chronic heart failure
  • Chronic lung disorders
  • Neurologic disorders
  • Dementia
  • Diabetes
  • End-stage liver disease
  • Neurologic disorders
  • Stroke
  • Mental health conditions