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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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:
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Drug Coverage
The CHRISTUS Health Medicare Plus (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic and specialty tier drugs at a standard pharmacy. For standard generic drugs, the copay is $47, and for preferred brand drugs, the copay is $100. Non-preferred drugs have a 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The CHRISTUS Health Medicare Plus (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays between $0 and $100. Emergency services have a $125 copay, and primary care visits, along with many specialist services, have a $25 copay. Additional benefits include coverage for hearing and vision services, with copays for exams and allowances for eyewear and hearing aids. Dental services are covered with a $25 copay for Medicare-covered services, with a $3,500 annual maximum for other services. The plan also covers home health services with no copay, and offers a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with additional days covered, and Inpatient Hospital Psychiatric, with a $50 copay for days 1-5 and no copay for days 6-90; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay 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 $100, observation services with a $100 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, are covered with a copay of $25. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the CHRISTUS Health Medicare Plus (HMO) plan. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $300 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 48 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the CHRISTUS Health Medicare Plus (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $30 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, and all three have no coinsurance.
Primary Care See details
The CHRISTUS Health Medicare Plus (HMO) plan covers primary care services, chiropractic services with a $20 copay, occupational therapy, physician specialist services with a $25 copay, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health and psychiatric services have a minimum and maximum copay of $25.
Preventive Services See details
Preventive services, including annual physical exams, are covered, with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission 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 are not covered. Additionally, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a $25 copay, routine hearing exams (1 per year) with a $25 copay, fitting/evaluation for hearing aids with no copay, prescription hearing aids (2 per year) with a copay between $395 and $1595, and OTC hearing aids (2 per year) with a copay between $95 and $295. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a $25 copay. Eyewear is covered with a combined maximum benefit of $300 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered with a limit of one per year. Upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $25 copay, and other dental services with a $3,500 maximum benefit per year. Oral Exams are covered with a $25 copay, up to 2 visits per year, and Dental X-Rays are covered with a $25 copay, up to 1 per year. Other diagnostic, preventive, and restorative services have a $20 copay, including Oral and Maxillofacial Surgery, while Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the CHRISTUS Health Medicare Plus (HMO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-15% coinsurance, Prosthetics/Medical Supplies - Non-Medicare benefit with a 15% coinsurance, Prosthetic Devices with a 15% coinsurance, Medical Supplies with a 15% coinsurance, and Diabetic Therapeutic Shoes/Inserts with a $10 copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $25 copay and Diagnostic Radiological Services with a $125 copay, while Lab Services are not covered. Therapeutic Radiological Services have a 20% coinsurance and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the CHRISTUS Health Medicare Plus (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 are covered, with a copay between $10 and $10 for Cardiac Rehabilitation Services. Pulmonary Rehabilitation Services are also covered, with a copay between $15 and $20. 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 the CHRISTUS Health Medicare Plus (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 stays for SNF are not covered.
Other Services See details
The CHRISTUS Health Medicare Plus (HMO) plan's other services include Over-the-Counter (OTC) items with a maximum benefit of $130 every three months, and a meal benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and various other services are not covered.
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