CHRISTUS Health Medicare Guardian (HMO)
H1189 - 008 - 0
(3 / 5)
CHRISTUS Health Medicare Guardian (HMO) is a Medicare Advantage (Part C) Plan by CHRISTUS Health Advantage.
This page features plan details for 2024 CHRISTUS Health Medicare Guardian (HMO) H1189 – 008 – 0 available in Northeast Texas.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
CHRISTUS Health Medicare Guardian (HMO) is offered in the following locations.
Plan Overview
CHRISTUS Health Medicare Guardian (HMO) offers the following coverage and cost-sharing.
| Insurer: | CHRISTUS Health Advantage |
| Health Plan Deductible: | $0.00 |
| MOOP: | $4,400 In-network |
| Drugs Covered: | No |
Ready to sign up for CHRISTUS Health Medicare Guardian (HMO) ?
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
CHRISTUS Health Medicare Guardian (HMO) qualifies for a monthly Medicare Give Back Benefit of $60.00.
| Premium Reduction: | $60.00 |
Premium Breakdown
CHRISTUS Health Medicare Guardian (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $60.00 | $114.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
CHRISTUS Health Medicare Guardian (HMO) also provides the following benefits.
| $0 |
| In-network | No |
| $4,400 In-network |
| No |
| In-network | No |
| $250 copay per visit (Authorization is not required.) (Referral is not required.) |
| Primary | $0 copay (Not applicable.) (Not applicable.) |
| Specialist | $25 copay per visit (Authorization is not required.) (Referral is not required.) |
| $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $75 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $35 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $40 copay (Authorization is not required.) (Referral is not required.) |
| Lab services | $0 copay (Authorization is not required.) (Referral is not required.) |
| Diagnostic radiology services (e.g., MRI) | $150 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient x-rays | $10 copay (Authorization is not required.) (Referral is not required.) |
| Hearing exam | $25 copay (Authorization is not required.) (Referral is not required.) |
| Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Office visit | $0.00 (Authorization is not required.) (Referral is not required.) |
| Oral exam | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Dental x-ray(s) | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | $20 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Diagnostic services | $20 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Restorative services | $20 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Endodontics | $20 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Periodontics | $20 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Extractions | $20 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $20 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | $20 copay (Authorization is not required.) (Referral is not required.) |
| Physical therapy and speech and language therapy visit | $25 copay (Authorization is not required.) (Referral is not required.) |
| $250 copay (Not applicable.) (Not applicable.) |
| $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Foot exams and treatment | $25 copay (Authorization is not required.) (Referral is not required.) |
| Routine foot care | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | 0-20% coinsurance (Authorization is not required.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Authorization is not required.) (Not applicable.) |
| Part B Insulin drugs | $0-35 copay (Authorization is not required.) (Not applicable.) |
| $0 per day for days 1 through 5 $0 per day for days 6 through 90 $320 per day for days 90 through 100 (Authorization is not required.) (Referral is not required.) |
| Inpatient hospital – psychiatric | $318 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is not required.) (Referral is not required.) |
| Outpatient group therapy visit with a psychiatrist | $25 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient individual therapy visit with a psychiatrist | $25 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient group therapy visit | $25 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient individual therapy visit | $25 copay (Authorization is not required.) (Referral is not required.) |
| $0 per day for days 1 through 20 $164.50 per day for days 21 through 100 (Authorization is not required.) (Referral is not required.) |
Ready to sign up for CHRISTUS Health Medicare Guardian (HMO) ?
Table of Contents
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