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 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 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:
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) plan offers comprehensive coverage for essential medical needs, featuring no copays or coinsurance for acute inpatient hospital stays, primary care visits, and annual preventive screenings. Specialist visits and routine therapy require a 40 dollar copay, while emergency room visits carry a 130 dollar copay which is waived if you are admitted to the hospital. Outpatient services are also highly affordable, with no copay for ambulatory surgical center procedures and no coinsurance overall. Additionally, the plan includes valuable extra benefits such as up to 48 one-way transportation trips per year and a 75 dollar quarterly over-the-counter allowance with no copay. Preventive dental services are fully covered with no copay up to a 2,500 dollar annual maximum, while routine vision and hearing exams are available for a 40 dollar copay. Members also receive a 250 dollar annual allowance for prescription eyewear with no copay and no coinsurance.
Inpatient Hospital See details
CHRISTUS Health Medicare Guardian (HMO) covers inpatient acute hospital stays with no copay and no coinsurance for unlimited days, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are partially covered with no coinsurance, featuring a $318 daily copay for days 1 through 5 and no copay for days 6 through 90, while additional days and non-Medicare-covered stays are excluded.
Outpatient Services See details
CHRISTUS Health Medicare Guardian (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services carry a copay of $0 to $325 (including $325 per stay for observation services), while individual and group outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by CHRISTUS Health Medicare Guardian (HMO) with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
CHRISTUS Health Medicare Guardian (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, 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 and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency and urgent care require a $130 copay and worldwide emergency transportation requires a $300 copay, all with no coinsurance.
Primary Care See details
CHRISTUS Health Medicare Guardian (HMO) provides primary care and telehealth services with no copay and no coinsurance. Most other covered services, including specialist visits, therapy, and mental health services, require a $40 copay and no coinsurance, while chiropractic services are partially covered with a $15 copay and no coinsurance for routine care, excluding other chiropractic services.
Preventive Services See details
Preventive Services are covered by CHRISTUS Health Medicare Guardian (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Additional preventive services are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
CHRISTUS Health Medicare Guardian (HMO) covers routine hearing exams once per year for a $40 copay and no coinsurance, alongside unlimited fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $395 to $1,595 for up to two aids per year, though inner ear, outer ear, and over the ear types are not covered. Up to two over-the-counter (OTC) hearing aids are also covered annually with no coinsurance and a copay of $95 to $295.
Vision Services See details
Vision services are partially covered by CHRISTUS Health Medicare Guardian (HMO), which offers one routine eye exam per year for a $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $250 annual limit for contacts or eyeglasses, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by CHRISTUS Health Medicare Guardian (HMO), featuring preventive care with no copay and no coinsurance up to a $2,500 annual maximum, and comprehensive services with a $20 copay and no coinsurance. Medicare-covered dental services require a $40 copay and no coinsurance, while 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. Under this plan, Medicare Part B insulin drugs require a $35 copay with no coinsurance, while Part B chemotherapy and other drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
CHRISTUS Health Medicare Guardian (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
CHRISTUS Health Medicare Guardian (HMO) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered with no coinsurance, though diabetic supplies are not covered and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by CHRISTUS Health Medicare Guardian (HMO), as laboratory services are not covered. Covered diagnostic procedures require a $75 copay and no coinsurance, outpatient X-rays have a $10 copay, diagnostic radiological services require a $150 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
CHRISTUS Health Medicare Guardian (HMO) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the CHRISTUS Health Medicare Guardian (HMO) plan, which features no coinsurance but excludes all major sub-services, including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD, from coverage.
Skilled Nursing Facility (SNF) See details
CHRISTUS Health Medicare Guardian (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Admission requires a prior three-day inpatient hospital stay, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
CHRISTUS Health Medicare Guardian (HMO) partially covers other services, offering a meal benefit for chronic illness and a $75 quarterly over-the-counter allowance with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, and naloxone are not covered under this benefit.
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