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Presbyterian Senior Care Plan 2 with Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Presbyterian Senior Care Plan 2 with Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Presbyterian Senior Care Plan 2 with Rx (HMO) in 2026, please refer to our full plan details page.
Presbyterian Senior Care Plan 2 with Rx (HMO) is a HMO plan offered by Presbyterian Healthcare Services available for enrollment in 2025 to people living in Counties: BER, CIB, RIO, SDV, SFE, SOC, TOR & VAL. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Presbyterian Senior Care Plan 2 with Rx (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 Presbyterian Senior Care Plan 2 with Rx (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 Presbyterian Senior Care Plan 2 with Rx (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 $6000.00 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 Presbyterian Senior Care Plan 2 with Rx (HMO)
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Drug Coverage
The Presbyterian Senior Care Plan 2 with Rx (HMO) features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for standard pharmacy fills or mail-order options. Tier 2 generic medications require a $10 copay for a one-month supply, with cost-saving opportunities available for multi-month supplies through mail order. Tier 3 preferred brand-name drugs carry a $45 copay for a one-month supply at standard pharmacies and through mail order. For higher-tier medications, Tier 4 non-preferred drugs have a 50% coinsurance, and Tier 5 specialty drugs require a 33% coinsurance for a one-month supply. This plan offers a balanced cost-sharing structure that helps keep everyday generic and brand-name medications highly affordable.
Additional Benefits
The Presbyterian Senior Care Plan 2 with Rx (HMO) offers comprehensive medical coverage with predictable costs, including no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a $30 copay, while emergency care has a $130 copay, both with no coinsurance. For hospital stays, inpatient care requires a $400 copay per day for the first five days and no copay thereafter, while outpatient hospital services carry a $350 copay. This plan also features valuable routine benefits, including dental cleanings and routine hearing exams with no copay and no coinsurance. Routine eye exams are highly affordable, ranging from no copay to a $5 copay, while prescription hearing aids require a copay between $499 and $999. Additionally, durable medical equipment is covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital and psychiatric care are partially covered by Presbyterian Senior Care Plan 2 with Rx (HMO) with no coinsurance, requiring a $400 copay per day for days 1 through 5 and no copay for days 6 and beyond. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Presbyterian Senior Care Plan 2 with Rx (HMO) covers outpatient hospital services with a $350 copay, observation services with a $250 copay, and ambulatory surgical center services with a $350 copay, all with no coinsurance. Outpatient blood services have no copay or coinsurance, and while some outpatient substance abuse services are covered, individual and group sessions are not covered.
Partial Hospitalization See details
Presbyterian Senior Care Plan 2 with Rx (HMO) covers partial hospitalization services with no coinsurance, though prior authorization is required. Depending on the specific service, you will pay either no copay or a $30 copay.
Ambulance and Transportation Services See details
Presbyterian Senior Care Plan 2 with Rx (HMO) partially covers ambulance and transportation services, offering ground and air ambulance services with a $350 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Presbyterian Senior Care Plan 2 with Rx (HMO) covers emergency services with a $130 copay, which is waived if admitted within 24 hours, and no coinsurance, alongside urgently needed services with a $20 to $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and a 20% coinsurance up to a maximum benefit of $50,000.
Primary Care See details
Presbyterian Senior Care Plan 2 with Rx (HMO) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist visits have a $30 copay and no coinsurance. Physical and occupational therapies require a $25 copay and no coinsurance, and chiropractic care is partially covered with a $15 copay and no coinsurance, but other chiropractic services are not covered. Podiatry is not covered, and for mental health and psychiatric specialty services, some services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
Presbyterian Senior Care Plan 2 with Rx (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. However, additional preventive services are only partially covered, excluding in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, and home safety modifications.
Hearing Services See details
Presbyterian Senior Care Plan 2 with Rx (HMO) offers partially covered hearing services, including one routine exam per year and unlimited fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $499 to $999, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Presbyterian Senior Care Plan 2 with Rx (HMO), offering one routine eye exam per year with a $0 to $5 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear features no copay and a 20% coinsurance for contact lenses, up to a combined maximum plan benefit of $265 per year for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered under the Presbyterian Senior Care Plan 2 with Rx (HMO), offering Medicare-covered dental for a $50 copay and no coinsurance, and routine exams, cleanings, x-rays, and fluoride treatments with no copay and no coinsurance. Restorative, endodontic, periodontic, prosthodontic, orthodontic, oral surgery, implant, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Presbyterian Senior Care Plan 2 with Rx (HMO) with prior authorization, requiring a $35 copay and between no coinsurance and 20% coinsurance for insulin. Other covered Part B drugs require a $10 copay and between no coinsurance and 20% coinsurance, while chemotherapy and radiation drugs incur a copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Presbyterian Senior Care Plan 2 with Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Presbyterian Senior Care Plan 2 with Rx (HMO) covers medical equipment with no copay, featuring a 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes or inserts. Medical supplies range from no coinsurance to 20% coinsurance, and diabetic equipment is partially covered as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Presbyterian Senior Care Plan 2 with Rx (HMO) partially covers diagnostic and radiological services, as diagnostic procedures, tests, and lab services are not covered. Covered diagnostic services require no copay and no coinsurance, while radiological services require prior authorization and carry a $30 copay for X-rays, a $290 copay for diagnostic radiology, and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Presbyterian Senior Care Plan 2 with Rx (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Presbyterian Senior Care Plan 2 with Rx (HMO) with no copay and no coinsurance. However, only some services are covered in practice, and cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Presbyterian Senior Care Plan 2 with Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $195 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Presbyterian Senior Care Plan 2 with Rx (HMO) partially covers other services, offering acupuncture with a $25 copay and no coinsurance, alongside chronic illness meals and over-the-counter items with no copay and no coinsurance. Nicotine replacement therapy, naloxone, and other additional services are not covered.
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