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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 Northeast Texas. 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 $20.00. 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:
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Drug Coverage
The CHRISTUS Health Medicare Plus (HMO) plan features an annual drug deductible of $250. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through three-month mail orders. For Tier 2 generic medications, standard pharmacy copays are $5 for a one-month supply, $10 for a two-month supply, and $15 for a three-month supply. Higher-tier medications under this plan require coinsurance instead of copays. Tier 3 preferred brand drugs carry a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 30% coinsurance at standard pharmacies. Standard three-month mail-order options for Tier 3 and Tier 4 drugs also require 25% and 30% coinsurance, respectively.
Additional Benefits
The CHRISTUS Health Medicare Plus (HMO) plan offers robust medical coverage with many essential services requiring no copay and no coinsurance, including primary care visits, telehealth, annual preventive screenings, and home health services. For specialized medical needs, members can expect predictable copayments with no coinsurance, such as a $30 copay for specialist visits, urgent care, and routine eye or hearing exams. Inpatient acute hospital stays and the first 20 days of skilled nursing facility care are also fully covered with no copay and no coinsurance. To further reduce out-of-pocket expenses, this plan features generous supplemental benefits, including preventive dental services with no copay up to a $4,000 yearly limit and up to $300 annually for eligible eyewear. Members also benefit from up to 48 one-way routine transportation trips per year and an over-the-counter allowance of up to $150 every three months, both with no copay. Emergency room visits carry a $125 copay with no coinsurance, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
CHRISTUS Health Medicare Plus (HMO) provides partially covered inpatient hospital benefits with no copay and no coinsurance for unlimited acute care stays, though upgrades and non-Medicare-covered stays are not covered. Psychiatric hospital stays feature no coinsurance, but require a $318 daily copay for days 1 through 5 and no copay for days 6 through 90, while additional psychiatric days 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 and outpatient blood services. Outpatient hospital services have a copay ranging from no copay to $325, while observation services require a $325 copay per stay and outpatient substance abuse sessions carry a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered by CHRISTUS Health Medicare Plus (HMO) with a $55.00 copayment and no coinsurance. This benefit provides structured psychiatric care as an alternative to inpatient hospitalization.
Ambulance and Transportation Services See details
CHRISTUS Health Medicare Plus (HMO) covers Medicare-approved ground and air ambulance services with a $300 copay and no coinsurance. Transportation services to plan-approved health-related locations are covered with no copay and no coinsurance for up to 48 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
CHRISTUS Health Medicare Plus (HMO) covers emergency services with a $125 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed care is covered with a $30 copay and no coinsurance, while worldwide emergency and urgent services require a $125 copay and worldwide emergency transportation has a $300 copay, both with no coinsurance.
Primary Care See details
Primary care benefits under the CHRISTUS Health Medicare Plus (HMO) plan are partially covered, offering primary care physician visits and telehealth services with no copay and no coinsurance. Most other covered services, including specialist visits, physical therapy, and mental health sessions, carry a $30 copay and no coinsurance, while routine chiropractic care has a $20 copay and no coinsurance (other chiropractic services are not covered).
Preventive Services See details
Preventive services are covered by CHRISTUS Health Medicare Plus (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings. Additional preventive services are partially covered with no copay and no coinsurance, but health education, PERS, medical nutrition therapy, weight management, alternative therapies, in-home safety assessments, medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling are not covered. Covered additional benefits are limited to memory fitness and remote access technologies.
Hearing Services See details
Hearing services covered by CHRISTUS Health Medicare Plus (HMO) include routine exams for a $30 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 $395 to $1,595 copay and no coinsurance, though inner ear, outer ear, and over the ear models are excluded from coverage.
Vision Services See details
Vision services are partially covered by CHRISTUS Health Medicare Plus (HMO) with no deductibles, though other eye exam services and eyewear upgrades are not covered. Routine eye exams require a $30 copay and no coinsurance, while eligible eyewear is covered with no copay or coinsurance up to a $300 annual maximum.
Dental Services See details
Dental Services are partially covered by CHRISTUS Health Medicare Plus (HMO), with no coverage for maxillofacial prosthetics and orthodontics. Preventive dental services feature no copay and no coinsurance up to a $4,000 yearly limit, while Medicare-covered services carry a $30 copay and comprehensive services require a $20 copay, both with no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by CHRISTUS Health Medicare Plus (HMO) with no copay, while associated Medicare Part B insulin drugs require a $35 copay and no coinsurance. Other covered Medicare Part B drugs, including chemotherapy and radiation, have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under CHRISTUS Health Medicare Plus (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is partially covered under CHRISTUS Health Medicare Plus (HMO), as diabetic supplies are not covered. Covered durable medical equipment has no copay and 0% to 15% coinsurance, prosthetics and medical supplies have no copay and 15% coinsurance, and diabetic therapeutic shoes or inserts require a $10 copay with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by CHRISTUS Health Medicare Plus (HMO), as laboratory services are not covered. Covered diagnostic procedures require a $50 copay, outpatient X-rays require a $15 copay, and diagnostic radiology has a minimum $125 copay, all with no coinsurance, while therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
Home health services are covered by the CHRISTUS Health Medicare Plus (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by CHRISTUS Health Medicare Plus (HMO) with no coinsurance, though some services are not covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered by this plan.
Skilled Nursing Facility (SNF) See details
CHRISTUS Health Medicare Plus (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a daily copay of $218 for days 21 through 100, with no coverage for additional days.
Other Services See details
CHRISTUS Health Medicare Plus (HMO) partially covers Other Services, excluding acupuncture while offering meal benefits for chronic illnesses and over-the-counter items of up to $150 every three months. Both the meal benefit and over-the-counter items are covered with no copay and no coinsurance.
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