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Presbyterian Senior Care Plan 1 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Presbyterian Senior Care Plan 1 (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 1 (HMO) in 2026, please refer to our full plan details page.
Presbyterian Senior Care Plan 1 (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 1 (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Presbyterian Senior Care Plan 1 (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 1 (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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4250.00 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 1 (HMO)
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Drug Coverage
Prescription drugs are not covered by Presbyterian Senior Care Plan 1 (HMO).
Additional Benefits
The Presbyterian Senior Care Plan 1 (HMO) offers comprehensive medical coverage featuring no copays for primary care visits, preventive services, home health, and cardiac rehabilitation. For inpatient hospital stays, members pay a $350 daily copay for the first five days and no copay thereafter, while outpatient hospital services require a $300 copay. Emergency care is available with a $130 copay, which is waived if admitted, alongside a $350 copay for ambulance services. Specialist visits require a $30 copay, while routine dental, vision, and hearing exams are highly accessible with no copays. Prescription hearing aids carry copays between $499 and $999, and durable medical equipment generally requires a 20% coinsurance with no copay. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a $185 daily copay.
Inpatient Hospital See details
Presbyterian Senior Care Plan 1 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay 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 1 (HMO) covers outpatient hospital and ambulatory surgical services with a $300 copay and no coinsurance, and observation services with a $225 copay per stay and no coinsurance. Outpatient blood services are covered with no copay or coinsurance, while outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial hospitalization services are covered under the Presbyterian Senior Care Plan 1 (HMO) with either no copay or a $30.00 copay, and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Presbyterian Senior Care Plan 1 (HMO) covers ground and air ambulance services with a $350 copay and no coinsurance per service. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered under the Presbyterian Senior Care Plan 1 (HMO) with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $20 to $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with no copay and 20% coinsurance.
Primary Care See details
Presbyterian Senior Care Plan 1 (HMO) covers primary care, telehealth, other health professionals, and opioid treatment with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Physical, occupational, and speech therapies have a $25 copay and no coinsurance, chiropractic services are partially covered with a $15 copay and no coinsurance (excluding other chiropractic services), and podiatry is not covered. Additionally, some mental health and psychiatric services are covered with no copay and no coinsurance, but individual and group sessions for both are not covered.
Preventive Services See details
Preventive services are partially covered by Presbyterian Senior Care Plan 1 (HMO) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and diabetes training. However, certain sub-services such as in-home safety assessments, personal emergency response systems, weight management programs, and alternative therapies are not covered.
Hearing Services See details
Hearing services are partially covered by Presbyterian Senior Care Plan 1 (HMO), offering 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 $499.00 to $999.00 for up to two devices per year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Vision services are covered by Presbyterian Senior Care Plan 1 (HMO), featuring partially covered eye exams with a $0 to $5 copay, no coinsurance, and no deductible, excluding other non-routine eye exam services. Eyewear is also covered with no copay, no deductible, and a 20% coinsurance for contact lenses, up to a $265 combined maximum limit every year.
Dental Services See details
Dental services are partially covered by the Presbyterian Senior Care Plan 1 (HMO), featuring Medicare-covered dental services for a $50 copay and no coinsurance. Preventive care like oral exams, cleanings, fluoride, and x-rays is offered with no copay and no coinsurance, but other diagnostic, restorative, endodontic, periodontic, prosthodontic, oral surgery, implant, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Presbyterian Senior Care Plan 1 (HMO) subject to prior authorization and step therapy. Covered Medicare Part B drugs, including chemotherapy and radiation, require a coinsurance ranging from no coinsurance to 20%, with additional copays of $35 for insulin and $10 for other Part B drugs.
Dialysis Services See details
Dialysis services are covered under the Presbyterian Senior Care Plan 1 (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Presbyterian Senior Care Plan 1 (HMO) covers medical equipment with no copay, requiring 20% coinsurance for durable medical equipment, prosthetic devices, and diabetic therapeutic shoes, and no coinsurance to 20% coinsurance for medical supplies. Diabetic equipment is partially covered, as diabetic supplies are not covered by the plan.
Diagnostic and Radiological Services See details
Presbyterian Senior Care Plan 1 (HMO) diagnostic and radiological services are partially covered, with diagnostic services carrying no copay or coinsurance, though diagnostic procedures, tests, and lab services are not covered. Covered radiological services require prior authorization and feature a $25 copay plus coinsurance for X-rays, a minimum $290 copay for diagnostic radiological services, and a minimum 20% coinsurance plus a copay for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by the Presbyterian Senior Care Plan 1 (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Presbyterian Senior Care Plan 1 (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance. Although some services are covered, specific sub-services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Presbyterian Senior Care Plan 1 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $185 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Presbyterian Senior Care Plan 1 (HMO) partially covers other services, offering acupuncture with a $25 copay and no coinsurance for up to 25 treatments per year, and chronic illness meal benefits with no copay and no coinsurance, though a referral is required. Over-the-counter (OTC) items are not covered under this plan.
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