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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4000.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies depending on the drug tier and pharmacy. For example, you'll pay $5.00 for preferred generic drugs at a standard pharmacy. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, your premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The CHRISTUS Health Medicare Plus (HMO) plan offers a range of benefits, including inpatient hospital stays with copays, outpatient services with copays ranging from $0 to $300, and ambulance services with a $300 copay. Primary care, preventive, hearing, vision, and dental services are also covered, each with varying copays. Additional benefits include home health services with no copay, cardiac rehabilitation with a $10 copay, and skilled nursing facility stays with copays after the initial 20 days. The plan also covers home infusion, dialysis, and medical equipment, and offers other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital-Acute has a $150 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a $275 copay for days 1-5, and no copay for days 6-90; non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $300, observation services with a $300 copay, and ambulatory surgical center services with no copay. Individual and group sessions for outpatient substance abuse have a copay of $10, but outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the CHRISTUS Health Medicare Plus (HMO) plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including Medicare-covered ground and air ambulance services, are covered. Ground and air ambulance services have a copay of $300.00. Transportation Services to a plan-approved health-related location are covered for 48 one-way trips per year, using rideshare services, bus/subway, medical transport, or other modes of transport. Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the CHRISTUS Health Medicare Plus (HMO) plan. Emergency Services and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay, and Worldwide Emergency Transportation has a $300 copay; all of these services have no coinsurance. Urgently Needed Services has a $25 copay and no coinsurance.
Primary Care See details
Primary Care services include primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology, additional telehealth benefits, and opioid treatment program services. Chiropractic services and routine chiropractic care have a $20 copay. Occupational therapy services, and physical therapy and speech-language pathology services have a $20 copay. Physician specialist services have a $25 copay. Individual and group sessions for mental health specialty services and psychiatric services have a $10 copay. Podiatry services and opioid treatment program services have a $25 copay. Other health care professional services have a copay between $0 and $25.
Preventive Services See details
Preventive services are covered, including annual physical exams, with no copay. However, health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Therapeutic massage and fitness benefits are covered.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, routine hearing exams (1 per year), fitting/evaluation for hearing aids, prescription hearing aids with a copay between $395 and $1595 (2 per year), and OTC hearing aids with a copay between $95 and $295 (2 per year). Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The CHRISTUS Health Medicare Plus (HMO) plan covers vision services, including eye exams with a $25 copay. Eyewear is covered with a combined maximum benefit of $300 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, each with a limit of one per year. Upgrades are not covered.
Dental Services See details
The CHRISTUS Health Medicare Plus (HMO) plan offers dental services with a $25 copay for Medicare Dental Services. Other dental services include oral exams with a $20 copay, Dental X-Rays, other diagnostic dental services, and preventive services like cleanings and fluoride treatments, all with varying limits. Restorative, adjunctive general, endodontics, periodontics, removable prosthodontics, implant services, fixed prosthodontics, and oral/maxillofacial surgery all have a $20 copay. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the CHRISTUS Health Medicare Plus (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment, though Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered. Durable Medical Equipment for use outside the home is also not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and therapeutic radiological services. Diagnostic Procedures/Tests have a copay of $150, while Therapeutic Radiological Services have a 20% coinsurance; lab services and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the CHRISTUS Health Medicare Plus (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, and include services not usually covered by Medicare plans. Cardiac Rehabilitation Services have a copay of $10, and Pulmonary Rehabilitation Services have a copay of $15-$20. Intensive Cardiac Rehabilitation Services and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by CHRISTUS Health Medicare Plus (HMO), with no copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a copay of $0-$45, and over-the-counter items with a maximum benefit of $205 every three months. The plan also offers a meal benefit for a chronic illness. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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