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CHRISTUS Health Medicare Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CHRISTUS Health Medicare Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CHRISTUS Health Medicare Plus (HMO) in 2026, please refer to our full plan details page.
CHRISTUS Health Medicare Plus (HMO) is a HMO plan offered by CHRISTUS Health available for enrollment in 2025 to people living in North Central New Mexico. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that CHRISTUS Health Medicare Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about CHRISTUS Health Medicare Plus (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For CHRISTUS Health Medicare Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for CHRISTUS Health Medicare Plus (HMO)
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Drug Coverage
The CHRISTUS Health Medicare Plus (HMO) plan features an annual drug deductible of $250. For prescription drug coverage, Tier 1 preferred generics and Tier 6 select care drugs offer no copay for standard pharmacy and standard mail-order fills. Tier 2 generic drugs are also highly affordable, requiring a standard pharmacy copay of just $5.00 for a one-month supply or $15.00 for a three-month supply. For higher-tier medications, coverage transitions to coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs incur a 30% coinsurance at standard pharmacies. Standard mail-order options for Tier 3 and Tier 4 medications also carry these respective coinsurance rates of 25% and 30% for a three-month supply.
Additional Benefits
The CHRISTUS Health Medicare Plus (HMO) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, telehealth, and home health services. For inpatient hospital stays, members pay a $150 daily copay for days 1 to 5 and no copay for subsequent days, while emergency room visits incur a $150 copay with no coinsurance. Specialist visits, urgent care, and outpatient therapy are also highly accessible with a $25 copay and no coinsurance. This plan also includes valuable supplemental benefits, such as preventive dental services with no copay and comprehensive dental coverage up to a $2,000 annual maximum. Routine eye exams and hearing exams require a $25 copay, with additional allowances of up to $300 annually for eyewear and a $150 quarterly over-the-counter allowance with no copay. Additionally, members benefit from up to 48 one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by CHRISTUS Health Medicare Plus (HMO) with no coinsurance, featuring a $150 daily copay for days 1 to 5 and no copay for days 6 and beyond for acute stays. Psychiatric stays also have no coinsurance, requiring a $275 daily copay for days 1 to 5 and no copay for days 6 to 90, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under CHRISTUS Health Medicare Plus (HMO) are covered with no coinsurance, featuring no copay for ambulatory surgical center (ASC) and blood services. Outpatient hospital services have a copay ranging from $0 to $300, including a $300 copay per stay for observation services, while outpatient substance abuse sessions require a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by CHRISTUS Health Medicare Plus (HMO) with a $55.00 copay and no coinsurance. This benefit ensures affordable access to structured care with clear and predictable out-of-pocket costs.
Ambulance and Transportation Services See details
CHRISTUS Health Medicare Plus (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance per trip. Transportation services are partially covered with no copay and no coinsurance for up to 48 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services for CHRISTUS Health Medicare Plus (HMO) are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are available for a $25 copay and no coinsurance, while worldwide emergency and urgent care have a $150 copay, and worldwide emergency transportation has a $300 copay, all with no coinsurance.
Primary Care See details
CHRISTUS Health Medicare Plus (HMO) provides primary care physician and telehealth services with no copay and no coinsurance. Specialist, therapy, psychiatric, and mental health services require a $25 copay and no coinsurance, while chiropractic services are partially covered with a $20 copay and no coinsurance for routine visits (other chiropractic services are not covered).
Preventive Services See details
CHRISTUS Health Medicare Plus (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, providing memory fitness and remote access technologies at no cost, though several services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
CHRISTUS Health Medicare Plus (HMO) hearing services include routine exams for a $25 copay and no coinsurance, alongside OTC hearing aids for a $95 to $295 copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $395 to $1,595 and no coinsurance, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by CHRISTUS Health Medicare Plus (HMO), which offers one routine eye exam per year for a $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $300 annual limit for one pair of glasses or contact lenses, though upgrades are not covered.
Dental Services See details
CHRISTUS Health Medicare Plus (HMO) offers partially covered dental services with an annual maximum benefit of $2,000. Preventive services like cleanings and exams have no copay and no coinsurance, Medicare-covered dental requires a $25 copay and no coinsurance, and comprehensive services carry a $20 copay and no coinsurance, with orthodontics and maxillofacial prosthetics not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by CHRISTUS Health Medicare Plus (HMO) with no copay, with Medicare Part B chemotherapy, radiation, and other Part B drugs requiring a 0% to 20% coinsurance. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by CHRISTUS Health Medicare Plus (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by CHRISTUS Health Medicare Plus (HMO) with no copays, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copay or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under CHRISTUS Health Medicare Plus (HMO), as lab services are not covered. Covered diagnostic procedures require a $50 copay with no coinsurance, while radiological services incur a $25 copay with coinsurance for X-rays, a minimum $150 copay with no coinsurance for diagnostic radiology, and a minimum 20% coinsurance plus copays for therapeutic radiology.
Home Health Services See details
Home health services are covered by CHRISTUS Health Medicare Plus (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the CHRISTUS Health Medicare Plus (HMO) plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by CHRISTUS Health Medicare Plus (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. This benefit requires a prior three-day inpatient hospital stay, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the CHRISTUS Health Medicare Plus (HMO) plan, featuring acupuncture with a $0 to $45 copay and no coinsurance for up to 20 treatments annually, and meals for chronic illness with no copay and no coinsurance. Over-the-counter items are covered with no copay and no coinsurance up to $150 every three months, but nicotine replacement therapy, naloxone, and certain over-the-counter drugs are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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