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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 2025, 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 2025.
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 a variety of benefits with varying costs. Inpatient hospital stays require a $350 copay for the first five days, and then no copay for the remaining days. Outpatient services and ambulance services have copays, while emergency services have a $125 copay. This plan also provides coverage for primary care, preventive, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic, home health, and skilled nursing facility services. Copays and coinsurance amounts vary depending on the specific service. The plan also covers acupuncture services with a $25 copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will also pay a $350 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center services, each with a copay of $350.00, $225.00, and $350.00 respectively. Outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Presbyterian Senior Care Plan 1 (HMO) and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Presbyterian Senior Care Plan 1 (HMO). Ground and Air Ambulance Services have a $350 copay, and there is no coinsurance. 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 1 (HMO). Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation have a $125 copay, while Urgently Needed Services have a copay between $20 and $55.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $20 copay, and routine chiropractic care has a $20 copay for up to 25 visits per year. Occupational Therapy and Physical Therapy have a $25 copay. Physician Specialist Services have a $55 copay. Mental Health Specialty Services and Psychiatric Services are not covered.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare, such as Health Education, Medical Nutrition Therapy, Re-admission Prevention, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, 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 Assessment, Personal Emergency Response System (PERS), 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. There is no cost for Medicare-covered preventive services.
Hearing Services See details
Hearing services include hearing exams with no deductible and no coinsurance, including routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $499 and $999, depending on the type of hearing aid, with a limit of 2 per year, but prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$15, and eyewear with a 20% coinsurance for contact lenses, with a combined maximum benefit of $250 per year. Routine eye exams are covered once per year.
Dental Services See details
Dental services with the Presbyterian Senior Care Plan 1 (HMO) include Medicare dental services with a $55 copay, plus 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, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Other Medicare Part B Drugs with a $15 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Presbyterian Senior Care Plan 1 (HMO), with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, while Durable Medical Equipment for use outside the home, and Diabetic Supplies are not covered. Medical Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Presbyterian Senior Care Plan 1 (HMO). Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $325.00, 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 1 (HMO) with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Presbyterian Senior Care Plan 1 (HMO).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Presbyterian Senior Care Plan 1 (HMO). There is no copay for days 1-20, but a $185 copay applies for days 21-100; there is no coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with a $25 copay, and a meal benefit that requires a doctor's referral; however, over-the-counter items, 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. Acupuncture is limited to 25 treatments per year.
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