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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 2026, 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 Central 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 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 a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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:
Sign up for CHRISTUS Health Medicare Plus (HMO)
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Drug Coverage
The CHRISTUS Health Medicare Plus (HMO) plan features an annual drug deductible of $250 and offers highly affordable options for generic medications. Beneficiaries enjoy no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care Drugs) prescriptions at standard pharmacies, as well as no copay for three-month standard mail orders. Tier 2 (Generic) drugs also have no copay at standard pharmacies, while a three-month standard mail order carries a low $10 copay. For brand-name and specialty medications, costs are structured around coinsurance rather than flat copays. Tier 3 (Preferred Brand) drugs require a 25% coinsurance for standard pharmacy and mail order options. Tier 4 (Non-Preferred) drugs and Tier 5 (Specialty) drugs both carry a 30% coinsurance, allowing you to easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The CHRISTUS Health Medicare Plus (HMO) plan offers comprehensive medical coverage with no copay or coinsurance for inpatient acute hospital stays, primary care visits, telehealth services, and routine preventive care. Outpatient services carry low copayments ranging from $0 to $200, while specialist visits and urgent care require a $40 copay. Emergency room visits have a $150 copay, which is waived if you are admitted, and ambulance services require a $300 copay. This plan also features robust supplemental benefits, including up to 48 one-way transportation trips per year to approved locations and a $100 quarterly allowance for over-the-counter items with no copay. Dental services feature no copay for preventive care up to a $3,000 annual limit and a $20 copay for comprehensive care, while routine vision and hearing exams require a $40 copay. Additionally, members benefit from a $300 annual allowance for eyewear with no copay and home health services with no copay or coinsurance.
Inpatient Hospital See details
CHRISTUS Health Medicare Plus (HMO) covers inpatient acute hospital stays with no copay, no coinsurance, and unlimited additional days, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital care is covered with no coinsurance, requiring a $50 copay for days 1 through 5 and no copay for days 6 through 90, though additional psychiatric days are not covered.
Outpatient Services See details
CHRISTUS Health Medicare Plus (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a $0 to $200 copay, observation services have a $200 copay per stay, and outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
CHRISTUS Health Medicare Plus (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
CHRISTUS Health Medicare Plus (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, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by CHRISTUS Health Medicare Plus (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency and urgent services are covered with a $150 copay ($300 for worldwide emergency transportation) and no coinsurance.
Primary Care See details
CHRISTUS Health Medicare Plus (HMO) covers primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist, therapy, and mental health visits require a $40 copay and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance for routine care, though other chiropractic services are not covered.
Preventive Services See details
CHRISTUS Health Medicare Plus (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, excluding services such as health education, in-home safety assessments, medical nutrition therapy, and weight management programs.
Hearing Services See details
CHRISTUS Health Medicare Plus (HMO) covers routine hearing exams with a $40 copay and no coinsurance, and fitting evaluations with no copay and no coinsurance. Hearing aid benefits are partially covered, offering over-the-counter devices for a $95 to $295 copay and prescription devices for a $395 to $1595 copay with no coinsurance, while inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
CHRISTUS Health Medicare Plus (HMO) provides partially covered vision services, offering one routine eye exam per year with a $40 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Covered eyewear has no copay, no coinsurance, and no deductible up to a $300 annual limit for one pair of contacts or eyeglasses, though upgrades are not covered.
Dental Services See details
CHRISTUS Health Medicare Plus (HMO) partially covers dental services, offering preventive care with no copay and no coinsurance up to a $3,000 annual maximum, and Medicare-covered dental for a $40 copay and no coinsurance. Comprehensive dental services like implants and oral surgery are covered with a $20 copay and no coinsurance, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by CHRISTUS Health Medicare Plus (HMO) with no copay and no coinsurance. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by CHRISTUS Health Medicare Plus (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by CHRISTUS Health Medicare Plus (HMO), including durable medical equipment with no copay and 0% to 15% coinsurance, and prosthetics and medical supplies with no copay and 15% coinsurance. Diabetic equipment is partially covered, offering therapeutic shoes and inserts for a $10 copay and no coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
CHRISTUS Health Medicare Plus (HMO) partially covers diagnostic and radiological services, though lab services are not covered. Covered diagnostic procedures and tests require a $25 copay and no coinsurance, while radiological benefits require a $10 copay for outpatient X-rays, a $100 copay for diagnostic radiological services, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by CHRISTUS Health Medicare Plus (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered with no coinsurance under CHRISTUS Health Medicare Plus (HMO), but some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation are not covered and require copayments of $10 to $15.
Skilled Nursing Facility (SNF) See details
CHRISTUS Health Medicare Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
CHRISTUS Health Medicare Plus (HMO) provides partial coverage for other services, featuring no copay and no coinsurance for chronic illness meal benefits and over-the-counter (OTC) items up to $100 every three months. Acupuncture is not covered under this plan's other services benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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