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 2025, 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 2025.
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 $125.00. 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:
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Drug Coverage
Prescription drugs are not covered by CHRISTUS Health Medicare Guardian (HMO).
Additional Benefits
The CHRISTUS Health Medicare Guardian (HMO) plan offers a wide range of benefits. Inpatient hospital stays have copays, with the amount varying based on the type of service and the number of days. Outpatient services have copays that vary, while ambulance services have a copay, and transportation services are available for a limited number of trips. This plan covers a variety of services with copays, including primary care, hearing, vision, and dental. Additionally, it includes benefits for home infusion, dialysis, medical equipment, diagnostic services, home health, cardiac rehabilitation, and skilled nursing facilities. Other services like acupuncture and over-the-counter items are also covered.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $150 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you pay a $275 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, 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 $325, and observation services with a $325 copay per stay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $10 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the CHRISTUS Health Medicare Guardian (HMO) plan. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CHRISTUS Health Medicare Guardian (HMO) plan, with no coinsurance for any services. Ground and air ambulance services have a $300 copay, while transportation services to a plan-approved health-related location are covered for up to 48 one-way trips per year, using rideshare services, bus/subway, medical transport, and other transportation methods.
Emergency Services See details
Emergency Services are covered, with a $125 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently Needed Services are covered, with a $30 copay and no coinsurance. Worldwide Emergency Services are also covered, with a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation, with no coinsurance for any of these services.
Primary Care See details
The CHRISTUS Health Medicare Guardian (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $25 copay, and mental health specialty services with a $10 copay for individual and group sessions. This plan also covers podiatry services with a $25 copay, other health care professional services with a copay between $0-$25, psychiatric services with a $10 copay for individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits, and opioid treatment program services with a $25 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Therapeutic massage and fitness benefits are covered, but additional preventive services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $25 copay, routine hearing exams, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay ranging from $395 to $1595, while OTC hearing aids have a copay between $95 and $295. However, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services include eye exams with a $25 copay, and coverage for routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses. Eyewear has a combined maximum benefit of $250 per year, and upgrades are not covered.
Dental Services See details
Dental services include a $25 copay for Medicare dental services, and a $2,000 maximum benefit per year. Oral exams are covered with a limit of 2 visits per year, and dental x-rays are covered with a limit of 1 per year. Other diagnostic dental services, other preventive services, and restorative services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered with a $20 copay. Fluoride treatment is covered up to 2 visits per year, and prophylaxis (cleaning) is covered up to 3 visits per year. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the CHRISTUS Health Medicare Guardian (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the CHRISTUS Health Medicare Guardian (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The CHRISTUS Health Medicare Guardian (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a $25 copay, though lab services are not covered. Diagnostic radiological services have a $150 copay and therapeutic radiological services have 20% coinsurance, while outpatient X-ray services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the CHRISTUS Health Medicare Guardian (HMO) plan with no copay and no coinsurance. However, 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, with a copay of $20.00. 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 under the CHRISTUS Health Medicare Guardian (HMO) plan, with no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a copay between $0 and $45 for up to 4 treatments per year, while the plan provides a maximum of $75 every three months for OTC items, and a meal benefit for chronic illness with no maximum coverage amount. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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, or Self-Directed Personal Assistance Services.
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