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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 Southeast 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. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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.
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:
Sign up for CHRISTUS Health Medicare Plus (HMO)
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Drug Coverage
The CHRISTUS Health Medicare Plus (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. The copay for standard generic drugs is $5, $47 for standard generic drugs, and $100 for preferred brand drugs. For non-preferred drugs, you will pay 33% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The CHRISTUS Health Medicare Plus (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services may have copays between $0 and $100. Emergency services have a $125 copay, and primary care visits have copays from $20-$25. Preventive services and home health services have no copay, and other benefits include hearing, vision, and dental services with copays and coinsurance. The plan also covers ambulance services, with a $300 copay, and offers an over-the-counter (OTC) benefit with a maximum of $175 every three months, as well as a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the CHRISTUS Health Medicare Plus (HMO) plan, with Inpatient Hospital-Acute benefits covered, including additional days, but not non-Medicare-covered stays or upgrades. Inpatient Hospital Psychiatric has a copay of $50 for days 1-5, and no copay for days 6-90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $100, observation services with a $100 copay, and ambulatory surgical center services with no copay. Individual and group sessions for outpatient substance abuse have 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. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for ambulance services. Ground and Air Ambulance Services have a $300 copay. Transportation Services to a plan-approved health-related location are covered for 48 one-way trips every year, and other transportation services 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 has a $125 copay, while Urgently Needed Services has a $30 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care and additional health benefits are covered by CHRISTUS Health Medicare Plus (HMO), including chiropractic services with a $20 copay, occupational therapy, physician specialist services, physical therapy and speech-language pathology services with a $25 copay, mental health specialty services, podiatry services, other health care professional, psychiatric services, and opioid treatment program services. Routine foot care has a $25 copay for up to 6 visits per year.
Preventive Services See details
Preventive services are covered, including annual physical exams, with no copay. Additional preventive services are partially covered, with Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 not covered. Fitness benefits and Remote Access Technologies are covered. Kidney Disease Education Services and Other Preventive Services including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams with a $25 copay, and prescription hearing aids with a copay between $395 and $1595 for all types, with a limit of 2 per year. OTC hearing aids are covered 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, and eyewear with a combined maximum benefit of $250 every year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $25 copay, and other dental services are covered with a $5,000 maximum benefit per year. Oral exams are covered with a $25 copay for up to 2 visits per year, and dental X-rays are covered with a $25 copay for up to one per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered with a $20 copay. 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 covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the CHRISTUS Health Medicare Plus (HMO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered under the CHRISTUS Health Medicare Plus (HMO) plan. Durable Medical Equipment (DME) is covered with a coinsurance between 0% and 15%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, and Medical Supplies have a 15% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
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. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $10 copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the CHRISTUS Health Medicare Plus (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 plans. For Cardiac Rehabilitation Services, the copay is between $10.00 and $10.00, and for Pulmonary Rehabilitation Services, the copay is 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 by the CHRISTUS Health Medicare Plus (HMO) plan. There is no copay for days 1-20, but there is a $214 copay for days 21-100; additional days beyond Medicare-covered for SNF are not covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the CHRISTUS Health Medicare Plus (HMO) plan, 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. Over-the-Counter (OTC) Items are covered with a maximum benefit of $175 every three months. A meal benefit is also covered for chronic illnesses.
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