A non-government entity
CHRISTUS Health Medicare Guardian (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CHRISTUS Health Medicare Guardian (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 Guardian (HMO) in 2026, please refer to our full plan details page.
CHRISTUS Health Medicare Guardian (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 Guardian (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about CHRISTUS Health Medicare Guardian (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 Guardian (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. Additionally, this plan comes with a Part B Premium reduction of $115.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4900.00 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 Guardian (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by CHRISTUS Health Medicare Guardian (HMO).
Additional Benefits
The CHRISTUS Health Medicare Guardian (HMO) provides robust medical coverage featuring no copay for primary care visits, telehealth, and routine preventive services. Specialist consultations, urgent care, and outpatient therapy sessions are highly accessible with a predictable $35 copay and no coinsurance. For major medical needs, inpatient hospital stays and emergency services are covered with set copays and no coinsurance, protecting you from high out-of-pocket costs. Beyond core medical care, this plan includes generous supplemental benefits like a $2,000 annual dental limit with no copay for preventive care, a $250 eyewear allowance, and up to 48 free one-way transportation trips per year. While home health services are covered with no copay, certain services like durable medical equipment, dialysis, and Part B drugs require up to a 20% coinsurance. Members also benefit from a $75 quarterly over-the-counter allowance with no copay to help cover everyday health essentials.
Inpatient Hospital See details
CHRISTUS Health Medicare Guardian (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, charging a $150 daily copay for days 1 to 5 of acute stays and a $275 daily copay for days 1 to 5 of psychiatric stays, with no copay for days 6 to 90. While additional acute stay days are unlimited, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
CHRISTUS Health Medicare Guardian (HMO) covers outpatient services with no coinsurance, featuring a copay ranging from no copay to $325 for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by CHRISTUS Health Medicare Guardian (HMO) with a $55.00 copay and no coinsurance. This benefit ensures affordable access to structured outpatient care with clear, predictable costs.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the CHRISTUS Health Medicare Guardian (HMO) plan, featuring a $300 copay and no coinsurance for both ground and air ambulance services. 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
CHRISTUS Health Medicare Guardian (HMO) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $30 copay, both featuring no coinsurance and no deductible. Worldwide emergency and urgent care are also covered with a $130 copay, while worldwide emergency transportation is covered with a $300 copay, all with no coinsurance.
Primary Care See details
CHRISTUS Health Medicare Guardian (HMO) provides primary care physician visits and telehealth services with no copay and no coinsurance. Specialist visits, therapy services, mental health sessions, and podiatry require a $35 copay and no coinsurance, while chiropractic benefits are partially covered with a $15 copay and no coinsurance for up to 24 routine visits per year.
Preventive Services See details
CHRISTUS Health Medicare Guardian (HMO) covers preventive services, including annual physical exams, kidney disease education, and screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, offering memory fitness and remote access technologies, while sub-services such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
CHRISTUS Health Medicare Guardian (HMO) covers routine hearing exams with a $35 copay, no deductible, and no coinsurance, as well as 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, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by CHRISTUS Health Medicare Guardian (HMO), featuring a $35 copay and no coinsurance for one routine annual eye exam, while other eye exam services are not covered. Covered eyewear has no copay and no coinsurance up to a $250 annual limit for one pair of contacts or eyeglasses, though eyewear upgrades are not covered.
Dental Services See details
CHRISTUS Health Medicare Guardian (HMO) offers partially covered dental services with an annual maximum of $2,000, featuring no copay and no coinsurance for preventive services, a $35 copay and no coinsurance for Medicare dental, and a $20 copay and no coinsurance for comprehensive care. Orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
CHRISTUS Health Medicare Guardian (HMO) covers Home Infusion bundled Services with no copay and no coinsurance. Under this benefit, Medicare Part B chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the CHRISTUS Health Medicare Guardian (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by CHRISTUS Health Medicare Guardian (HMO) with no copays, but coinsurance up to 20% applies to durable medical equipment, prosthetic devices, and medical supplies. This benefit is partially covered, as diabetic equipment features no copay or coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
CHRISTUS Health Medicare Guardian (HMO) partially covers diagnostic and radiological services, as lab services are not covered. Diagnostic procedures and tests require a $50 copay with no coinsurance, while outpatient x-rays have a $20 copay, diagnostic radiological services require a $150 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by CHRISTUS Health Medicare Guardian (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by CHRISTUS Health Medicare Guardian (HMO) with no coinsurance, though some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered. These excluded services require copayments ranging between $10 and $20.
Skilled Nursing Facility (SNF) See details
CHRISTUS Health Medicare Guardian (HMO) covers skilled nursing facility (SNF) care with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. A prior three-day inpatient hospital stay is required for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by CHRISTUS Health Medicare Guardian (HMO), featuring acupuncture with a $0 to $45 copay and no coinsurance, and chronic illness meals and a $75 quarterly over-the-counter allowance with no copay and no coinsurance. Nicotine replacement therapy, naloxone, and dual-eligible SNP services are not covered under these benefits.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved