CHRISTUS Health Plan Guardian (HMO)
H1189 - 006 - 0
(4 / 5)
CHRISTUS Health Plan Guardian (HMO) is a Medicare Advantage Plan by CHRISTUS Health Plan Generations.
This page features plan details for 2023 CHRISTUS Health Plan Guardian (HMO) H1189 – 006 – 0 available in Southeast Texas.
IMPORTANT: This page features the 2023 version of this plan. See the 2025 version using the link below:
No 2025 version found. You can use the location links below to find 2025 plans in your area.
Locations
CHRISTUS Health Plan Guardian (HMO) is offered in the following locations.
Plan Overview
CHRISTUS Health Plan Guardian (HMO) offers the following coverage and cost-sharing.
| Insurer: | CHRISTUS Health Plan Generations |
| Health Plan Deductible: | $0.00 |
| MOOP: | $4,400 In-network |
| Drugs Covered: | No |
Ready to sign up for CHRISTUS Health Plan Guardian (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
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 Plan Guardian (HMO) qualifies for a monthly Medicare Give Back Benefit of $60.00.
| Premium Reduction: | $60.00 |
Premium Breakdown
CHRISTUS Health Plan 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 |
|---|---|---|---|
| $164.90 | $0.00 | $60.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
CHRISTUS Health Plan Guardian (HMO) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| Diagnostic services: | Not covered (no limits) |
| Endodontics: | Not covered (no limits) |
| Extractions: | Not covered (no limits) |
| Non-routine services: | Not covered (no limits) |
| Periodontics: | Not covered (no limits) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered (no limits) |
| Restorative services: | Not covered (no limits) |
Dental (preventive)
| Cleaning: | $5 copay (limits may apply) (authorization not required) (referral not required) |
| Dental x-ray(s): | $5 copay (limits may apply) (authorization not required) (referral not required) |
| Fluoride treatment: | $5 copay (limits may apply) (authorization not required) (referral not required) |
| Oral exam: | $5 copay (limits may apply) (authorization not required) (referral not required) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | $150 copay (authorization required) (referral required) |
| Diagnostic tests and procedures: | $50 copay (authorization required) (referral required) |
| Lab services: | $0 copay (authorization required) (referral required) |
| Outpatient x-rays: | $25 copay (authorization required) (referral required) |
Doctor visits
| Primary: | $0 copay |
| Specialist: | $25 copay per visit (authorization not required) (referral not required) |
Emergency care/Urgent care
| Emergency: | $75 copay per visit (always covered) |
| Urgent care: | $35 copay per visit (always covered) |
Foot care (podiatry services)
| Foot exams and treatment: | $25 copay (authorization required) (referral required) |
| Routine foot care: | $0 copay (no limits) (authorization required) (referral required) |
Ground ambulance
| $265 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | Not covered (no limits) |
| Hearing aids: | $395-695 copay (no limits) (authorization required) (referral required) |
| Hearing exam: | $25 copay (authorization not required) (referral not required) |
Hospital coverage (inpatient)
| $320 per day for days 1 through 5 $0 per day for days 6 through 90 $320 per day for days 91 through 100 (authorization required) (referral required) |
Hospital coverage (outpatient)
| $325 copay per visit (authorization required) (referral required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $4,400 In-network |
Medical equipment/supplies
| Diabetes supplies: | $0 copay (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | 20% coinsurance per item (authorization required) |
Medicare Part B drugs
| Chemotherapy: | 20% coinsurance (authorization required) |
| Other Part B drugs: | 20% coinsurance (authorization required) |
Mental health services
| Inpatient hospital – psychiatric: | $318 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral required) |
| Outpatient group therapy visit: | $40 copay (authorization required) (referral required) |
| Outpatient group therapy visit with a psychiatrist: | $40 copay (authorization required) (referral required) |
| Outpatient individual therapy visit: | $40 copay (authorization required) (referral required) |
| Outpatient individual therapy visit with a psychiatrist: | $40 copay (authorization required) (referral required) |
Optional supplemental benefits
| No |
Preventive care
| $0 copay (authorization not required) (referral not required) |
Rehabilitation services
| Occupational therapy visit: | $25 copay (authorization required) (referral required) |
| Physical therapy and speech and language therapy visit: | $25 copay (authorization required) (referral required) |
Skilled Nursing Facility
| $0 per day for days 1 through 20 $164.50 per day for days 21 through 100 (authorization required) (referral required) |
Transportation
| $0 copay (limits may apply) (authorization required) (referral required) |
Vision
| Contact lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass frames: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglasses (frames and lenses): | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Other: | Not covered (no limits) |
| Routine eye exam: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Upgrades: | Not covered |
Wellness programs (e.g., fitness, nursing hotline)
| Covered (authorization required) (referral required) |
Ready to sign up for CHRISTUS Health Plan Guardian (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST