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Imperial Senior Value (C-SNP) Plan Details for Santa Barbara County, CA

This page provides coverage and cost details for Imperial Health Plan of California, Inc.’s H5496-005-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.

CMS 2025 Rating: ☆☆☆☆☆*

*CMS rated this Imperial Health Plan of California, Inc. plan (H5496-005-0) 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 Imperial Health Plan of California, Inc. 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.

Imperial Senior Value Basic Plan Details

Plan ID
H5496-005-0
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
297.00 /yr (in-network)
Part B Reduction
$0.00/mo
Drug Plan Benefit
Enhanced
$0.00 deductible
Supplemental Benefits
Vision, Hearing
Availability
Santa Barbara County, CA
Insured By
Imperial Health Plan of California, Inc.

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 Imperial Health Plan of California, Inc. plan:

Doctor's Office Visits

Primary
Not Covered
Specialist
Not Covered

Emergency, Urgent, and Inpatient Hospital Coverage

Emergency room care
$125 Copay
Urgent care
Not Covered
Ground ambulance
$150 Copay
Inpatient hospital care
$0.00 per day for days 1 through 90
Skilled Nursing Facility
$0.00 per day for days 1 through 20
$100.00 per day for days 21 through 50
$200.00 per day for days 51 and beyond

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
$0.00 per day for days 1 through 90

Rehabilitation Services

Physical therapy and speech and language therapy
Not Covered
Occupational therapy
$0 Copay
Prior Authorization Required, Referral Required

Medical Equipment and Supplies

Diabetes supplies
Not Covered
Durable medical equipment
20% Coinsurance
Prior Authorization Required
Prosthetics
20% Coinsurance

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
20% Coinsurance
Other Part B drugs (Medicare-covered)
20% Coinsurance

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
Maximum dental benefit
$500.00 (Every year)

Hearing Aids and Services

Fitting/evaluation
Covered
Limits may apply
Hearing aids
Covered
Limits may apply
Hearing exam
Covered
Limits may apply

Vision Services

Medicare-covered eye exam
Routine eye exam
Covered
Limits may apply
Eyewear benefits
None

Prescription Drug Costs & Benefits

Imperial Senior Value 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 $0.00. You must pay this amount at the pharmacy before Imperial Health Plan of California, Inc. begins paying its share.

Prescription Drug Out-of-Pocket Costs

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

Drug Tier Retail Mail Order
Preferred Generic$0.00$0.00
Generic$6.00$0.00
Preferred Brand$45.00$0.00
Non-Preferred Drug$90.00$0.00
Specialty Tier33.00%0.00%
Select Care Drugs$3.00$0.00
*The Part D deductible does not apply.

How to Qualify to Enroll in
Imperial Senior Value

To be eligible to enroll in Imperial Senior Value, you must meet these requirements:

  1. You are eligible for Medicare;
  2. You live in Santa Barbara 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