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Imperial Courage Plan (HMO) Medicare Advantage Plan H5496-016 • 2027

CMS Rating: ☆☆☆☆☆ (4.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$2999.00In-network
Part B Giveback
−$85.00 reduction
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
408 beneficiaries
Last update:

Imperial Courage Plan (HMO) Introduction

Imperial Courage Plan is a Medicare Advantage HMO plan offered by Imperial Health Plan of California, Inc.. It uses a Health Maintenance Organization (HMO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $2999.00 in-network maximum out-of-pocket. CMS Plan ID H5496-016 identifies this plan.

Plan Benefits

Imperial Courage 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 H5496-016.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay In-network: $0 copay
Specialist In-network: $5 copay In-network: $5 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam Not covered Not covered
Telehealth benefit In-network: $0 copay In-network: $0 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits Not covered In-network: $0 copay
Health transportation (non-emergency) Coming soon In-network: $0 copay

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0 copay In-network: $0 copay
Lab services In-network: $0 copay In-network: $0 copay
Outpatient x-rays In-network: $0 copay In-network: $0 copay
Diagnostic tests and procedures In-network: $0 copay In-network: $0 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $125 copay $125 copay
Worldwide emergency care Coming soon $0 copay
Urgent care $0 copay $0 copay
Inpatient hospital care Tier 1
$150 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Tier 1
$150 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Skilled Nursing Facility Tier 1
$0 per day for days 1-20
$200 per day for days 21-100		 Tier 1
$0 per day for days 1-20
$200 per day for days 21-100
Ground ambulance In-network: $150 copay In-network: $150 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $0 copay In-network: $0 copay
Outpatient group therapy In-network: $0 copay In-network: $0 copay
Inpatient psychiatric hospital care Tier 1
$150 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Tier 1
$150 per day for days 1-5
$0 per day for days 6-90
$0 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: 20% coinsurance In-network: 20% coinsurance
Occupational therapy In-network: $10 copay In-network: $10 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay In-network: $0 copay
Durable medical equipment In-network: 20% coinsurance In-network: 20% coinsurance
Prosthetics In-network: 20% coinsurance In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam Not covered In-network: $0 copay
Dental x-rays Not covered In-network: $0 copay
Cleaning Not covered In-network: $0 copay
Periodontics Not covered In-network: $0 copay
Endodontics Not covered In-network: $0 copay
Restorative services Not covered In-network: $0 copay
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery Not covered In-network: $0 copay

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam Not covered In-network: $0 copay
Contact lenses Not covered In-network: $0 copay
Eyeglass frames only Not covered Not covered
Eyeglass lenses only Not covered Not covered
Eyeglasses (frames & lenses) Not covered In-network: $0 copay
Upgrades Not covered Not covered

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam Not covered In-network: $0 copay
Fitting/evaluation Not covered In-network: $0 copay
Prescription hearing aids Not covered In-network: $0 copay
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by Imperial Courage Plan as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Performance Ratings (Contract ID: H5496)

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.

2027 Medicare Star Ratings for Contract H5496
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for Imperial Health Plan of California, Inc.

Website
Imperial Health Plan of California, Inc. Plan Page
Providers
Imperial Health Plan of California, Inc. Providers Page
Formulary
Imperial Health Plan of California, Inc. Formulary Page
Pharmacy
Imperial Health Plan of California, Inc. Pharmacy Page
New Member Health Plan Help
(800)838-5914
New Member Health Plan TTY
711

Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.

Plan Availability

Imperial Courage Plan (H5496-016-0) is available in the following locations:

California Counties Served

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About Imperial Courage Plan (HMO)

How much does plan H5496-016 cost per month?

The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.

What is the MOOP for Imperial Courage Plan in 2027?

The 2027 in-network MOOP is $2999.00. Once this limit is reached, covered in-network costs are fully covered.

How many beneficiaries are enrolled in this plan?

CMS reports 408 beneficiaries enrolled in this plan.

What is the prescription drug deductible for 2027?

For 2027, the prescription drug deductible is $0.00.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Imperial Health Plan of California, Inc. (official source) http://www.imperialhealthplan.com 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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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.