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Presbyterian Senior Care Plan 3 with Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Presbyterian Senior Care Plan 3 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 3 with Rx (HMO) in 2025, please refer to our full plan details page.
Presbyterian Senior Care Plan 3 with Rx (HMO) is a HMO plan offered by Presbyterian Healthcare Services available for enrollment in 2025 to people living in Greater Albuquerque Area, Rio Arriba and Santa Fe. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Presbyterian Senior Care Plan 3 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 3 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 3 with Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $118.00. 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 $3750.00 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 3 with Rx (HMO)
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Drug Coverage
The Presbyterian Senior Care Plan 3 with Rx (HMO) has an enhanced alternative drug benefit with a $0 deductible. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For example, standard generic drugs have a $45 copay, while preferred brand drugs have 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D will be $14.40.
Additional Benefits
The Presbyterian Senior Care Plan 3 with Rx (HMO) offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. It also covers a range of services like primary care, preventive services, hearing, vision, and dental, each with specific copays or coinsurance requirements. Additionally, the plan provides benefits such as ambulance, emergency, and home health services, and some other services such as acupuncture and over-the-counter items. While the plan offers robust benefits, certain services have limitations or are not covered, such as specific mental health, dental, and vision services. Costs for services vary, with copays and coinsurance applying to various categories, so it is important to consult the details provided for the specific service you are seeking.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $300 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Hospital Services and Ambulatory Surgical Center (ASC) Services have a $200 copay, while Observation Services have a $225 copay per stay; however, Individual and Group Sessions for Outpatient Substance Abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Presbyterian Senior Care Plan 3 with Rx (HMO) with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Presbyterian Senior Care Plan 3 with Rx (HMO). Ground and Air Ambulance Services have a $325 copay and no coinsurance, while 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 Presbyterian Senior Care Plan 3 with Rx (HMO). Emergency Services have a $125 copay, and no coinsurance, while Urgently Needed Services have a copay between $10 and $55, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay and no coinsurance.
Primary Care See details
The Presbyterian Senior Care Plan 3 with Rx (HMO) covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, physician specialist services with a $30 copay, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits, and opioid treatment program services. Mental Health Specialty Services and Psychiatric Services individual and group sessions, as well as podiatry services are not covered.
Preventive Services See details
The Presbyterian Senior Care Plan 3 with Rx (HMO) covers preventive services, including annual physical exams, with no copay. The plan also covers health education, medical nutrition therapy, re-admission prevention, additional sessions for smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, counseling services, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, and home and bathroom safety devices and modifications are not covered.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids (all types) are covered with a copay between $499 and $999, twice per year.
Vision Services See details
Vision Services include coverage for eye exams with a copay between $0 and $15, and eyewear with 20% coinsurance. Routine eye exams are covered once per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered. The plan has a combined maximum benefit of $250.00 per year for all eyewear.
Dental Services See details
Dental Services include Medicare dental services with a $45 copay, along with oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, each limited to a certain number of visits per year. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Other Medicare Part B Drugs have a $10 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Presbyterian Senior Care Plan 3 with Rx (HMO), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the Presbyterian Senior Care Plan 3 with Rx (HMO). Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Medical Supplies have a 0-20% coinsurance, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $250.00, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $25.00 copay.
Home Health Services See details
Home Health Services are covered by the Presbyterian Senior Care Plan 3 with Rx (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20, and a $185 copay for days 21-100.
Other Services See details
Other Services include acupuncture with a $25 copay, Over-the-Counter (OTC) Items with a $20 maximum benefit every three months, and a meal benefit requiring a doctor's referral. 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.
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