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Presbyterian Dual Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Presbyterian Dual Plus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Presbyterian Dual Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Presbyterian Dual Plus (HMO D-SNP) is a HMO D-SNP plan offered by Presbyterian Healthcare Services available for enrollment in 2025 to people living in State of New Mexico. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Presbyterian Dual Plus (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Presbyterian Dual Plus (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Presbyterian Dual Plus (HMO D-SNP).
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 Dual Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.90. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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:
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Drug Coverage
The Presbyterian Dual Plus (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible, you will pay coinsurance for your prescriptions depending on the drug tier and pharmacy. In the initial coverage phase, you will pay 25% or 26% coinsurance depending on the drug tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The Presbyterian Dual Plus (HMO D-SNP) plan provides comprehensive coverage, including inpatient and outpatient services, with varying coinsurance costs. You'll have a 20% coinsurance for many services like outpatient, emergency, and primary care, but some services like hearing exams and vision exams have specific cost structures. This plan offers additional benefits such as hearing aids up to $2000 every two years, and eyewear coverage with a combined maximum benefit of $275 per year. Dental services are also included, with a maximum benefit of $3,000 per year for various procedures. You can also expect no copay for home health services, and a $200 every three months for over-the-counter (OTC) items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with coinsurance costs that align with Original Medicare. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a minimum and maximum coinsurance of 20%. Outpatient blood services are covered with a 20% coinsurance, and the plan waives the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Presbyterian Dual Plus (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, with no copay. Transportation services to a plan-approved health-related location are covered for up to 50 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered with a 20% coinsurance, and Urgently Needed Services are covered with a 20% coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Presbyterian Dual Plus (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have a 20% coinsurance. Occupational therapy services, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and opioid treatment program services have a minimum and maximum 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as additional services like Health Education, Medical Nutrition Therapy, Nutritional/Dietary Benefits, Additional Sessions of Smoking and Tobacco Cessation Counseling, Telemonitoring Services, and Fitness Benefits, with some services requiring 20% coinsurance. Annual physical exams, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, 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, Enhanced Disease Management, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids are covered up to $2000 every two years, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for routine eye exams with 20% coinsurance, limited to one exam every year, and eyewear with 20% coinsurance and a combined maximum benefit of $275 per year. Eyewear coverage includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services include coverage for Medicare Dental Services with 20% coinsurance. Other Dental Services have a maximum benefit of $3,000 per year, and include Oral Exams (2 visits per year), Dental X-Rays (1 per year), Prophylaxis (Cleaning) (2 per year), Fluoride Treatment (2 per year), Restorative Services, Adjunctive General Services, Endodontics, Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery. Prosthodontics, removable and Prosthodontics, fixed are limited to every 5 years. This plan does not cover Implant Services or Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Presbyterian Dual Plus (HMO D-SNP) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
The Presbyterian Dual Plus (HMO D-SNP) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires prior authorization, but does not have a copay. Prosthetic Devices and Medical Supplies are covered with a coinsurance of 0% to 20%, and also do not have a copay. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Presbyterian Dual Plus (HMO D-SNP) plan 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 not covered by the Presbyterian Dual Plus (HMO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and the coinsurance information is available in the plan details.
Other Services See details
The Presbyterian Dual Plus (HMO D-SNP) plan does not cover acupuncture, 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. The plan covers over-the-counter (OTC) items with a maximum benefit of $200 every three months, and covers a meal benefit for chronic illnesses.
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