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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 2026, 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 2026.
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 $114.00. 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:
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) 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 purchases or mail-order options. Tier 2 generic medications require a $10 copay for a one-month supply, which can increase up to $30 for standard three-month fills or drop to $20 for preferred mail-order fills. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply, with three-month supplies costing $135 at standard pharmacies or a reduced $112.50 through preferred mail order. High-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance for a one-month supply.
Additional Benefits
The Presbyterian Senior Care Plan 3 with Rx (HMO) provides comprehensive coverage for core medical services, offering primary care visits, telehealth, and home health services with no copay or coinsurance. For inpatient hospital stays, members pay a $350 daily copay for the first five days and no copay thereafter, while specialist visits require a $30 copay. Emergency care is available with a $130 copay, and outpatient hospital services carry a $250 copay, both with no coinsurance. Supplemental benefits include routine hearing and preventive dental exams with no copay, alongside an annual routine eye exam featuring up to a $5 copay. Prescription hearing aids are covered with copays ranging from $499 to $999, while eyewear has a combined annual maximum benefit of $265. Additionally, skilled nursing facility stays have no copay for the first 20 days, and durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Presbyterian Senior Care Plan 3 with Rx (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 copay per day for days 1 through 5 and no copay for days 6 and beyond. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Presbyterian Senior Care Plan 3 with Rx (HMO) covers outpatient hospital and ambulatory surgical center services with a $250 copay and no coinsurance, and observation services with a $225 copay per stay and no coinsurance. Outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services are not covered in practice since both individual and group sessions are excluded.
Partial Hospitalization See details
Presbyterian Senior Care Plan 3 with Rx (HMO) covers partial hospitalization services with a copay ranging from no copay up to $30.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Presbyterian Senior Care Plan 3 with Rx (HMO) covers ground and air ambulance services with a $325 copay and no coinsurance, which is not waived if you are admitted to the hospital. While transportation services are technically covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Presbyterian Senior Care Plan 3 with Rx (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $10 to $50 copay and no coinsurance, while worldwide emergency services are covered with no copay and a 20% coinsurance up to a $50,000 maximum limit.
Primary Care See details
Presbyterian Senior Care Plan 3 with Rx (HMO) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Occupational, physical, and speech therapies have a $15 copay and no coinsurance, whereas podiatry is not covered, and chiropractic services are partially covered with a $15 copay and no coinsurance (other chiropractic services are not covered). For mental health and psychiatric services, some services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by the Presbyterian Senior Care Plan 3 with Rx (HMO) with no copay and no coinsurance for covered benefits, though some services require a referral. Covered benefits include annual physical exams, kidney disease education, and nutritional therapy, while services such as in-home safety assessments, personal emergency response systems (PERS), weight management, and alternative therapies are not covered.
Hearing Services See details
Hearing services are partially covered by the Presbyterian Senior Care Plan 3 with Rx (HMO), featuring routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $499 to $999 for up to two devices per year, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Presbyterian Senior Care Plan 3 with Rx (HMO), offering one annual routine eye exam with a $0 to $5 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, a 20% coinsurance for contact lenses, and a combined annual maximum benefit of $265 for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Presbyterian Senior Care Plan 3 with Rx (HMO) offers partially covered dental services, featuring Medicare-covered dental care for a $45 copay and no coinsurance, alongside select preventive services with no copay and no coinsurance. Restorative, endodontic, periodontic, prosthodontic, orthodontic, implant, oral surgery, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Presbyterian Senior Care Plan 3 with Rx (HMO) covers home infusion bundled services with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for Part B insulin. Other covered Part B drugs require a $10 copay and no coinsurance to 20% coinsurance, while chemotherapy and radiation drugs require a copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Presbyterian Senior Care Plan 3 with Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Presbyterian Senior Care Plan 3 with Rx (HMO) with no copays, but durable medical equipment, prosthetic devices, and diabetic therapeutic shoes require a 20% coinsurance. Medical supplies are covered with coinsurance ranging from no coinsurance to 20%, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Presbyterian Senior Care Plan 3 with Rx (HMO), requiring prior authorization for radiology. For diagnostic services, some services are covered with no copay and no coinsurance, but diagnostic procedures, tests, and lab services are not covered. Covered radiological services include outpatient X-rays with a $25 copay and coinsurance, diagnostic radiology with a $250 copay and no coinsurance, and therapeutic radiology with a 20% coinsurance and a copay.
Home Health Services See details
Home health services are covered by Presbyterian Senior Care Plan 3 with Rx (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Presbyterian Senior Care Plan 3 with Rx (HMO). All associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Presbyterian Senior Care Plan 3 with Rx (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $185 daily copay for days 21 through 100, though days beyond the standard 100-day benefit period are not covered.
Other Services See details
Presbyterian Senior Care Plan 3 with Rx (HMO) partially covers other services, including acupuncture for a $25 copay and no coinsurance up to 25 treatments yearly, and chronic illness meals with no copay and no coinsurance. Over-the-counter items are covered with no copay and no coinsurance up to $25 every three months, though nicotine replacement therapy, naloxone, and dual-eligible SNP services are not covered.
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