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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 South Texas. 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:
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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 will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you will pay a $0 copay for preferred generic drugs at a standard pharmacy, while standard generic drugs have a $47 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The CHRISTUS Health Medicare Plus (HMO) plan provides comprehensive coverage with a range of benefits. This plan includes coverage for inpatient and outpatient services, with varying copays depending on the service. You'll find no copay for inpatient hospital stays and outpatient ASC services, while other services like emergency care and specialist visits have copays. The plan also offers additional benefits such as vision, dental, and hearing services, with copays for exams and specific services. You'll also have coverage for prescription hearing aids with a copay and eyewear with a combined maximum benefit. Additionally, the plan covers ambulance services, home health, and cardiac rehabilitation with specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute with no coinsurance and no copay for additional days, but Non-Medicare-covered Stay and upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric services have a $50 copay for days 1-5 and no copay for days 6-90, but additional days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $100, and observation services with a $100 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $25 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the CHRISTUS Health Medicare Plus (HMO) plan. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground and air ambulance services have a copay of $300, with no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 48 one-way trips per year. Transportation services to any health-related location are 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 have a $125 copay, and Urgently Needed Services have a $30 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The CHRISTUS Health Medicare Plus (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy, physician specialist services with a $25 copay, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health and psychiatric services have a $25 copay, and routine foot care has a $25 copay for up to 6 visits per year.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with no copay, annual physical exams, and other preventive services. Additional services like health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a $25 copay, routine hearing exams (1 per year), fitting/evaluation for hearing aids, and OTC hearing aids with a copay between $95 and $295 for 2 hearing aids every year. Prescription hearing aids are partially covered, with only Prescription Hearing Aids (all types) being covered with a copay between $395 and $1595 for 2 hearing aids every year, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - 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. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $250 every year, but upgrades are not covered.
Dental Services See details
The CHRISTUS Health Medicare Plus (HMO) plan covers dental services, including oral exams with a $25 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered with a $20 copay, but maxillofacial prosthetics and orthodontics are not covered. There is a $3,000 maximum plan benefit coverage per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered by the CHRISTUS Health Medicare Plus (HMO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, with coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the CHRISTUS Health Medicare Plus (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 15%, while Prosthetic Devices and Medical Supplies have a 15% coinsurance. Diabetic Therapeutic Shoes/Inserts have a $10 copay, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $25 copay, Diagnostic Radiological Services with a $125 copay, and Outpatient X-Ray Services with a $10 copay. However, Lab Services are not covered, and Therapeutic Radiological Services have a 20% coinsurance.
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, including services not usually covered by Medicare plans, with a copay of $10.00 for Cardiac Rehabilitation Services. Pulmonary Rehabilitation Services are also covered with a copay between $15.00 and $20.00. 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 the CHRISTUS Health Medicare Plus (HMO) plan, with no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $190 every three months, and a Meal Benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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