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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 Southeast 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 significant savings on generic medications. Beneficiaries pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies or through standard mail order. For Tier 2 generic drugs, copays at standard pharmacies are $5 for a 1-month supply, $10 for a 2-month supply, and $15 for a 3-month supply, or $10 for a 3-month standard mail order. For brand-name and specialty medications, costs are structured as a percentage of the drug price. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 30% coinsurance at standard pharmacies. Standard mail order options for Tier 3 and Tier 4 drugs also carry these respective 25% and 30% coinsurance rates for a 3-month supply.
Additional Benefits
The CHRISTUS Health Medicare Plus (HMO) plan offers robust coverage with no copay or coinsurance for inpatient acute hospital stays, primary care visits, and home health services. Outpatient services and emergency care are also highly accessible, with emergency room visits requiring a $150 copay that is waived if you are admitted, while specialist visits carry a low copay of $20 to $25. Additionally, the plan provides convenient transportation benefits, offering up to 48 one-way trips per year to approved medical locations with no copay. For supplemental care, members enjoy comprehensive dental coverage up to a $3,000 annual limit with no copay for preventive services and a low $20 copay for comprehensive procedures. Routine vision and hearing exams are available for a $25 copay, with additional allowances of up to $250 annually for eyewear and a $100 quarterly credit for over-the-counter items. Prescription hearing aids are also covered with no coinsurance and copays ranging from $395 to $1,595 per device.
Inpatient Hospital See details
CHRISTUS Health Medicare Plus (HMO) covers inpatient acute hospital stays with no copay, no coinsurance, and unlimited additional days, although upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance, requiring a $50 copay per day for days 1 through 5 and no copay for days 6 through 90, though additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by CHRISTUS Health Medicare Plus (HMO) with no coinsurance, including ambulatory surgical center and outpatient blood services which also have no copay. Outpatient hospital services carry a copay of $0 to $300, while outpatient substance abuse individual and group sessions require a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by CHRISTUS Health Medicare Plus (HMO) 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 per service. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by CHRISTUS Health Medicare Plus (HMO) with a $150 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $150 to $300.
Primary Care See details
Primary care benefits under CHRISTUS Health Medicare Plus (HMO) include primary care physician and telehealth visits with no copay and no coinsurance. Most other services, such as specialist visits, therapy, and mental health sessions, require a copay of $20 to $25 and no coinsurance, though chiropractic care is only partially covered as other chiropractic services are excluded.
Preventive Services See details
Preventive services under the CHRISTUS Health Medicare Plus (HMO) plan are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are only partially covered, with memory fitness and remote access technologies included, while services such as health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services covered by CHRISTUS Health Medicare Plus (HMO) include routine hearing exams for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $395 and $1,595 (inner ear, outer ear, and over the ear models are not covered), while OTC hearing aids require no coinsurance and a $95 to $295 copay. Both prescription and OTC hearing aid benefits are limited to two devices per year.
Vision Services See details
Vision services are partially covered by CHRISTUS Health Medicare Plus (HMO), offering one routine eye exam per year for a $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $250 annual maximum for contact lenses or eyeglasses, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by CHRISTUS Health Medicare Plus (HMO) up to a $3,000 annual maximum, offering preventive care with no copay and no coinsurance, Medicare-covered dental services for a $25 copay and no coinsurance, and comprehensive services for a $20 copay and no coinsurance. 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, though associated Medicare Part B drugs require cost-sharing. Covered Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the CHRISTUS Health Medicare Plus (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered under the CHRISTUS Health Medicare Plus (HMO) plan, featuring no copay and 0% to 15% coinsurance for durable medical equipment, and no copay with 15% coinsurance for prosthetics and medical supplies. 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
CHRISTUS Health Medicare Plus (HMO) diagnostic and radiological services are partially covered because lab services are not covered. Diagnostic procedures and tests require a $25 copay and no coinsurance, while radiological services incur a $10 copay for X-rays, a $100 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are fully covered under the CHRISTUS Health Medicare Plus (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by CHRISTUS Health Medicare Plus (HMO) with no copay and no coinsurance; however, while some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
CHRISTUS Health Medicare Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 copayment for days 21 through 100. A prior three-day inpatient hospital stay is required for admission, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other services are partially covered by CHRISTUS Health Medicare Plus (HMO), including a chronic illness meal benefit and up to $100 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, and naloxone are not covered.
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