UCLA Health Medicare Advantage Principal Plan (HMO) Medicare Advantage Plan H4647-001 • 2027 • Los Angeles County, CA
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $2499.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $300.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Los Angeles County, CA
- Local Enrollment
- 3,682 beneficiaries in Los Angeles County
UCLA Health Medicare Advantage Principal Plan (HMO) Introduction
UCLA Health Medicare Advantage Principal Plan is a Medicare Advantage HMO plan offered by UCLA Health Medicare Advantage Plan. It uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $2499.00 in-network maximum out-of-pocket. CMS Plan ID H4647-001 identifies this plan. The 2027 Part D prescription drug deductible is $300.00.
You must live in Los Angeles County, California to enroll in this plan. CMS reports 3,682 beneficiaries enrolled in this plan in Los Angeles County. For assistance with this plan, new members can call (833)627-8252 (TTY 711).
Compare Similar Plans in Los Angeles County
Compare this plan with the two most-enrolled HMO plans available in Los Angeles County, California. Enrollment is based on CMS local enrollment data.
| Plan Detail | UCLA Health Medicare Advantage Principal Plan | Kaiser Permanente Senior Advantage LA, Orange Co. | SCAN Classic |
|---|---|---|---|
| CMS Plan ID | H4647-001-0 |
H0524-003-0 |
H5425-006-0 |
| Local Enrollment | 3,682 | 181,296 | 85,264 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $2,499.00 | $999.00 | $299.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $0 copay | $0 copay | $0 copay |
| Part D Deductible | $300.00 | $0.00 | $370.00 |
| CMS Star Rating | 3.5 | 4.5 | 4.0 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | Not covered | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Los Angeles County, or compare Medicare Advantage plans across California, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
UCLA Health Medicare Advantage Principal Plan has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H4647-001.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H4647-001-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $0 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- In-network: $0 copay
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$50 copay
- Lab services
- In-network: $0 copay
- Outpatient x-rays
- In-network: $0 copay
- Diagnostic tests and procedures
- In-network: $0 copay
Emergency and Urgent Care Services
- Emergency room care
- $150 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $15 copay
- Inpatient hospital care
- Tier 1
$200 per stay - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$100 per day for days 21-100 - Ground ambulance
- In-network: $200 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $15 copay
- Outpatient group therapy
- In-network: $15 copay
- Inpatient psychiatric hospital care
- Tier 1
$200 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $0 copay
- Occupational therapy
- In-network: $0 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 20%-50% coinsurance
- Prosthetics
- In-network: 0%-20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: $0-$130 copay
- Endodontics
- In-network: $12-$154 copay
- Restorative services
- In-network: $7-$410 copay
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $3-$152 copay
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $295-$1495 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by UCLA Health Medicare Advantage Principal Plan as a Part B benefit.
Prescription Drug Coverage
UCLA Health Medicare Advantage Principal Plan includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $300.00 annual Part D deductible. You'll pay this deductible at the pharmacy before UCLA Health Medicare Advantage Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, UCLA Health Medicare Advantage Principal Plan may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | $47.00 copay | Coming soon |
| Non-Preferred Drug | 27% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H4647)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Contact Information for UCLA Health Medicare Advantage Plan
- Website
- UCLA Health Medicare Advantage Plan Plan Page
- Providers
- UCLA Health Medicare Advantage Plan Providers Page
- Formulary
- UCLA Health Medicare Advantage Plan Formulary Page
- Pharmacy
- UCLA Health Medicare Advantage Plan Pharmacy Page
- New Member Health Plan Help
- (833)627-8252
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)627-8252
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Advantage Plan Availability
UCLA Health Medicare Advantage Principal Plan is available to eligible Medicare beneficiaries residing in Los Angeles County, California, including communities such as Los Angeles, West Hollywood, Playa Vista, Bell Gardens, Beverly Hills, Compton, Culver City, Downey, El Segundo, Gardena, Hawthorne, Hermosa Beach, Huntington Park, Lawndale, Lynwood, Malibu, Manhattan Beach, Maywood, Pacific Palisades, Palos Verdes Peninsula, Rancho Palos Verdes, Redondo Beach, South Gate, Topanga, Venice, Marina Del Rey, Playa Del Rey, Inglewood, Santa Monica, Torrance, Whittier, La Mirada, Montebello, Norwalk, Pico Rivera, Santa Fe Springs, Artesia, Cerritos, Avalon, Bellflower, Harbor City, Lakewood, Hawaiian Gardens, Lomita, Paramount, San Pedro, Wilmington, Carson, Signal Hill, Long Beach, Altadena, Arcadia, Duarte, La Canada Flintridge, Monrovia, Montrose, Sierra Madre, South Pasadena, Sunland, Tujunga, Pasadena, San Marino, Glendale, La Crescenta, Agoura Hills, Calabasas, Canoga Park, Winnetka, West Hills, Chatsworth, Encino, Newhall, Northridge, Porter Ranch, Pacoima, Reseda, San Fernando, Sylmar, North Hills, Granada Hills, Mission Hills, Santa Clarita, Canyon Country, Sun Valley, Valencia, Tarzana, Woodland Hills, Stevenson Ranch, Castaic, Van Nuys, Panorama City, Sherman Oaks, Burbank, North Hollywood, Studio City, Valley Village, Azusa, Baldwin Park, Claremont, Covina, El Monte, South El Monte, Glendora, La Puente, Hacienda Heights, Rowland Heights, La Verne, Monterey Park, Diamond Bar, Pomona, Rosemead, San Dimas, San Gabriel, Temple City, Walnut, West Covina, Alhambra, Acton, Lake Hughes, Lancaster, Littlerock, Palmdale, Pearblossom, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| UCLA Health Medicare Advantage Plan (official source) | http://www.UCLAhealthmedicareadvantage.org | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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