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 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 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 $4400.00 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)
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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 range of benefits, including inpatient and outpatient hospital services, with varying copays. You'll have access to primary care, specialist visits, and mental health services, all with set copays. The plan also includes coverage for hearing, vision, and dental services, with specific copays and annual limits for eyewear and dental procedures. This plan provides coverage for emergency services, ambulance transportation, and home health services. It also includes coverage for prescription hearing aids, and a quarterly allowance for over-the-counter items. Additionally, the plan covers skilled nursing facility stays, cardiac rehabilitation, and offers benefits for home infusion and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with additional days covered, and Inpatient Hospital Psychiatric, which has a $318 copay for days 1-5 and no copay for days 6-90. The plan does not cover Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, or Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $300, and observation services with a $300 copay. Ambulatory Surgical Center (ASC) services have no copay, and outpatient substance abuse services have a $40 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 Guardian (HMO) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CHRISTUS Health Medicare Guardian (HMO) plan, including both ground and air ambulance services. Ground and air ambulance services have a copay of $300, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered for up to 48 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the CHRISTUS Health Medicare Guardian (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $35 copay, and both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $300 copay; all three have no coinsurance.
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, Mental Health Specialty Services with a $25 copay for individual and group sessions, Podiatry Services with a $25 copay for routine foot care (up to 6 visits per year), Other Health Care Professional services with a copay ranging from $0 to $25, Psychiatric Services with a $25 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services with a $25 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. The plan does not cover health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, 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.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with a copay between $95 and $295; prescription hearing aids are partially covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered. Routine hearing exams are covered once per year, prescription hearing aids are covered twice per year, and OTC hearing aids are covered once per year.
Vision Services See details
Vision Services includes eye exams with a $25 copay, and also covers routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, with a combined maximum of $250 per year for eyewear. Upgrades are not covered.
Dental Services See details
The CHRISTUS Health Medicare Guardian (HMO) plan covers dental services with a $25 copay for Medicare Dental Services and a $20 copay for Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery. Oral Exams are covered with a limit of 2 per year, Dental X-Rays are covered with a limit of 1 per year, and Prophylaxis (Cleaning) is covered with a limit of 3 per year. Other services such as 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. 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. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0-20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay, and Medicare-covered Prosthetic Devices and Medical Supplies have a 20% 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 include coverage for Diagnostic Procedures/Tests with a $40 copay, while Lab Services are not covered. Radiological Services include coverage for Diagnostic Radiological Services with a copay of $150, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and Additional Cardiac Rehabilitation Services are covered under the CHRISTUS Health Medicare Guardian (HMO) plan. Cardiac Rehabilitation Services and Pulmonary Rehabilitation Services have a copay between $20 and $15, and there is a copay for Additional Cardiac Rehabilitation Services. 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 Guardian (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 SNF stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months, and a meal benefit for chronic illnesses, but acupuncture, 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, and Self-Directed Personal Assistance Services are not covered.
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