2027 Medicare Advantage plan

ProCare Advantage – Diabetes Care Management (HMO-POS C-SNP): 2027 benefits and costs

ProCare Advantage HMO-POS C-SNP Special Needs Plan

CMS plan ID: H3467-005-0 · Plan year: 2027

ProCare Advantage – Diabetes Care Management (HMO-POS C-SNP) is a 2027 Medicare Advantage plan offered by ProCare Advantage. It is listed in Texas.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$350.00

In-network medical out-of-pocket maximum$3,400.00

Organization: ProCare Advantage
Plan organization: PROCARE ADVANTAGE, LLC
Parent company: First Sacramento Capital Funding LLC
Plan type: HMO-POS C-SNP
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
Special Needs Plan type: Chronic or Disabling Condition
2027 CMS Star Rating: Not enough data available

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
Combined in/out-of-network medical deductible: None
Out-of-network medical deductible: None
In-network medical maximum: $3,400.00
Combined in/out-of-network medical maximum: $3,400.00
Out-of-network medical maximum: Not applicable

Who can join this Special Needs Plan?

This plan is for people with qualifying chronic or disabling conditions. The plan must confirm that your condition meets its eligibility rules.

Plan eligibility type: Chronic or Disabling Condition
Qualifying conditions: Diabetes mellitus

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	Point-of-service	What to know
Primary care doctor	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.
Specialist visit	$0 Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Telehealth	20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Emergency care	$90.00 copay	Not summarized. Check coverage with the plan.
Urgent care	20% coinsurance	Not summarized. Check coverage with the plan.
Home health	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No
Dialysis	20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Not summarized. Check coverage with the plan.	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Not summarized. Check coverage with the plan.	Approval required Yes
Kidney disease education services	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Medicare-covered chiropractic	20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No
Medicare-covered foot care	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Other health professionals	$20.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–5: $190.00 copay per day Days 6–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Original Medicare
Inpatient mental health care	$0.00 copay per stay Days 1–5: $190.00 copay per day Days 6–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Original Medicare
Skilled nursing facility	Original Medicare cost-sharing rules apply.	Approval required Yes Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	20% coinsurance Service-specific deductible No
Hospital observation services	20% coinsurance Service-specific deductible No
Ambulatory surgical center	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Outpatient blood	20% coinsurance Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$0 Service-specific deductible No	Approval required Yes Referral required No
Laboratory services	$0 Service-specific deductible No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Therapeutic radiology	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
X-rays	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Substance use treatment, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Opioid treatment program	$0 Service-specific deductible No	Approval required Yes Referral required No
Mental health, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Mental health, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	Point-of-service	What to know
Occupational therapy	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Physical and speech therapy	$0 Service-specific deductible No	20% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Cardiac rehabilitation	20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No
Intensive cardiac rehabilitation	20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No
Pulmonary rehabilitation	20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No
Supervised exercise for peripheral artery disease	20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Air ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Durable medical equipment	20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	$0 Service-specific deductible No	Approval required No
Diabetic shoes and inserts	$0 Service-specific deductible No	Approval required No
Diabetic monitors	$0 Service-specific deductible No	Approval required No

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	20% coinsurance
Oral examsAdditional plan benefit	$0
Dental X-raysAdditional plan benefit	$0
Other diagnostic dentalAdditional plan benefit	$0
Dental cleaningAdditional plan benefit	$0
FluorideAdditional plan benefit	$0
Restorative dental careAdditional plan benefit	$0
Root canal treatment (endodontics)Additional plan benefit	$0
Gum treatment (periodontics)Additional plan benefit	$0
Removable dentures (prosthodontics)Additional plan benefit	$0
Fixed dental restorations (prosthodontics)Additional plan benefit	$0
Oral surgeryAdditional plan benefit	$0
Other dental servicesAdditional plan benefit	$0

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0	Approval required No Referral required No
Medicare-covered eyewear	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	20% coinsurance Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Limited-duration mealsAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

Flex Card

One shared limit covers the listed services, not a separate allowance for each service.

Full allowance details are not summarized here.

Transportation

One shared limit covers the listed services, not a separate allowance for each service.

Full allowance details are not summarized here.

Benefits for qualifying members

Food, Produce, Transportation, Hygiene

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Diabetes mellitus
Included services: Food and produce; Transportation for non-medical needs; Other 1 Non-Primarily Health Related Benefit
Applies to out-of-network or point-of-service care: No
Some package benefits are exempt from the deductible: Yes
Services exempt from the deductible: Food and produce; Transportation for non-medical needs; Other 1 Non-Primarily Health Related Benefit
Package limit: $0.00
How often this limit applies: Every month
How benefits are provided: Debit Card
Services sharing the package limit: Food and produce; Transportation for non-medical needs; Other 1 Non-Primarily Health Related Benefit

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	90 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	25%	25%	25%
Tier 4Non-Preferred Drug	50%	50%	50%
Tier 5Specialty Tier	29%	Not listed	Not listed

Mail-order and other pharmacies

Out-of-network pricing: The standard retail copay or coinsurance applies, but the number of days you can fill is limited. Check the supply lengths below and the plan’s out-of-network rules.

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	90 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	25%	25%	25%
Tier 4Non-Preferred Drug	50%	50%	50%
Tier 5Specialty Tier	29%	Not listed	Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	25%
Tier 4Non-Preferred Drug	50%
Tier 5Specialty Tier	29%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	10 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	25%
Tier 4Non-Preferred Drug	50%
Tier 5Specialty Tier	29%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

View all locations 12 county listings across 1 state or territory