Presbyterian Senior Care Plan 1 (HMO)

H3204 - 008 - 0
3 out of 5 stars (3 / 5)

Presbyterian Senior Care Plan 1 (HMO) is a Medicare Advantage Plan by Presbyterian Health Plan.

This page features plan details for 2025 Presbyterian Senior Care Plan 1 (HMO) H3204 – 008 – 0 available in Greater Albuquerque Area, Rio Arriba and Santa Fe.

Locations

Presbyterian Senior Care Plan 1 (HMO) is offered in the following locations.

Plan Overview

Presbyterian Senior Care Plan 1 (HMO) offers the following coverage and cost-sharing.

Insurer:Presbyterian Health Plan
Health Plan Deductible:$0
MOOP:$4,250 In-network
Drugs Covered:No

Ready to sign up for Presbyterian Senior Care Plan 1 (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

Premium Breakdown

Presbyterian Senior Care Plan 1 (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
$185.00 $0.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Presbyterian Senior Care Plan 1 (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • $325 copay (Authorization Required)
  • Diagnostic tests and procedures
    • $0 copay
  • Lab services
    • $0 copay
  • Outpatient x-rays
    • $25 copay (Authorization Required)

Doctor visits

  • Primary
    • $0 copay
  • Specialist
    • $55 copay per visit

Emergency care/Urgent care

  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $20-55 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • $0 copay
  • Routine foot care
    • Not covered

Ground ambulance

    • $350 copay

Health plan deductible

    • $0

Hearing

  • Hearing aids
    • $499-999 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • $0 copay
  • Fitting/evaluation
    • $0 copay

Inpatient hospital coverage

    • $350 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $4,250 In-network

Medical equipment/supplies

  • Diabetes supplies
    • $0 copay
  • 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
    • 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • $15 copay or 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient individual therapy visit with a psychiatrist
    • $0 copay
  • Outpatient group therapy visit
    • $0 copay
  • Inpatient hospital – psychiatric
    • $350 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • $0 copay
  • Outpatient individual therapy visit
    • $0 copay

Optional supplemental benefits

    • Yes

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $350 copay per visit (Authorization Required)

Preventive care

    • $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • $25 copay
  • Occupational therapy visit
    • $25 copay

Skilled Nursing Facility

    • $0 per day for days 1 through 20
      $185 per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • $0 copay (Limits Apply)
  • Eyeglass frames
    • $0 copay (Limits Apply)
  • Other
    • Not covered
  • Routine eye exam
    • $0 copay (Limits Apply)
  • Eyeglass lenses
    • $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply)
  • Upgrades
    • $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Optional Comprehensive Dental Buy-Up

Comprehensive Dental

  • Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, Maxillofacial Prosthetics, Prosthodontics, fixed, Oral and Maxillofacial Surgery, Adjunctive General Services
    • Monthly Premium: $25.90
    • Max Coverage: $4000.00
    • Coverage Periodicity: Every year

Ready to sign up for Presbyterian Senior Care Plan 1 (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

Need more information on Presbyterian Senior Care Plan 1 (HMO)? See 2025 Presbyterian Senior Care Plan 1 (HMO) at MedicareAdvantageRX.com.

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