California PHP
Find a provider, facility or Pharmacy- Plan Benefits and Costs
- Changes to Plan Benefits and Costs for 2024
- Premium, Maximum Out-of-Pocket Costs, Deductible for 2024
- Medical Benefits and Costs for 2024
- Prescription Drug Coverage and Costs for 2024
- Premium, Maximum Out-of-Pocket Costs, Deductible for 2023
- Medical Benefits and Costs for 2023
- Prescription Drug Coverage and Costs for 2023
- Medical Services
- Prescription Drugs
- Health & Wellness Benefit
- Member Materials and More
- Getting Care or Prescription Drugs During a Disaster
- Manage Your Membership
- Contact Us
- En Español
- Plan Benefits and Costs
- Changes to Plan Benefits and Costs for 2024
- Premium, Maximum Out-of-Pocket Costs, Deductible for 2024
- Medical Benefits and Costs for 2024
- Prescription Drug Coverage and Costs for 2024
- Premium, Maximum Out-of-Pocket Costs, Deductible for 2023
- Medical Benefits and Costs for 2023
- Prescription Drug Coverage and Costs for 2023
- Medical Services
- Prescription Drugs
- Health & Wellness Benefit
- Member Materials and More
- Getting Care or Prescription Drugs During a Disaster
- Manage Your Membership
- Contact Us
- En Español
Medical Services
PHP (HMO SNP) offers all the benefits that Original Medicare does through its network of HIV primary care doctors, specialists and hospitals.
For 2023 and 2024, PHP has no monthly Part D premium! You must continue to pay your Medicare Part B premium.
PHP has no cost sharing for most medical services and no Part B deductible for 2023 and 2024. Original Medicare has a $240 Part B deductible for 2024.
Compare PHP’s 2024 coverage and costs for these benefits with Original Medicare.
Benefits | Original Medicare | PHP | PHP |
Doctor Office Visits (includes visits to primary care and specialist providers) | 20% coinsurance (You pay 20% of the cost of the visit) | $0 copay per visit to primary care provider (PCP) or specialist. | $0 copay per visit to primary care provider (PCP) or specialist. |
Emergency Care | 20% coinsurance for the doctor’s services. Specified copayment for outpatient hospital facility emergency services. Emergency services copay cannot exceed Part A inpatient hospital deductible for each service provided by the hospital. | $75 copay | $25 copay |
Urgently Needed Services | 20% coinsurance, or a set copay. | $0 copay | $0 copay |
Outpatient Services | 20% coinsurance for the doctor’s services. Specified copayment for outpatient hospital facility services. Copay cannot exceed Part A inpatient hospital deductible. 20% coinsurance for ambulatory surgical center facility services. | $0 copay for outpatient services. Some services require referral and authorization. | $0 copay for outpatient services. Some services require referral and authorization. |
Diagnostic Tests, X-Rays, Lab Services, and Radiology Services | 20% coinsurance for diagnostic tests and x-rays. $0 copay for Medicare-covered lab services. | You pay nothing for the following services:
Referral required. The following services require authorization:
The following services do not require authorization:
| You pay nothing for the following services:
Referral required. The following services require authorization:
The following services do not require authorization:
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Inpatient Hospital Care | In 2024, the amounts for each benefit period are:
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Skilled Nursing Facility (SNF) | In 2024, the amounts for each benefit period are:
Three-day inpatient hospital stay required before going into SNF. |
No prior hospital stay is required. |
No prior hospital stay is required. |
You can also see the 2024 Summary of Benefits. This publication lists most of the plan’s benefits.
If you like PHP’s medical benefits, you’ll like its prescription drug benefit.
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