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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 2026, 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 2026.
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 $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.
This plan has a $550.00 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 $9250.00 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) Medicare plan features an annual drug deductible of $550. For Tier 1 preferred generic drugs, members pay no copay for one-month, two-month, or three-month supplies filled at standard pharmacies or through standard mail order. For Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, members pay a 25% coinsurance at standard pharmacies and standard mail order. This 25% coinsurance applies to one-month, two-month, and three-month supplies for Tiers 2 through 4, while Tier 5 specialty drugs are covered for a one-month supply.
Additional Benefits
The Presbyterian Dual Plus (HMO D-SNP) offers comprehensive medical coverage featuring no copays for major services, including inpatient hospital stays, primary care, emergency care, and outpatient services. While there are no copays for these essential services, a standard 20% coinsurance applies to most outpatient care, specialist visits, and diagnostic testing. Notably, inpatient hospital care and home health services are fully covered with no copay and no coinsurance. To support overall wellness, the plan includes valuable supplemental benefits like dental care up to a $3,000 annual limit and hearing aids up to $2,000 every two years with no copays. Members also receive a $275 eyewear allowance, up to 50 free one-way transportation trips, and a $165 quarterly over-the-counter allowance with no copays or coinsurance. These additional offerings ensure key routine health needs are met with minimal out-of-pocket costs.
Inpatient Hospital See details
Presbyterian Dual Plus (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric care with no copay and no coinsurance, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Presbyterian Dual Plus (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services.
Partial Hospitalization See details
Presbyterian Dual Plus (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Presbyterian Dual Plus (HMO D-SNP), requiring a 20% coinsurance and no copay for both ground and air ambulance rides. Transportation benefits are partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Presbyterian Dual Plus (HMO D-SNP) covers emergency and urgently needed services with no copay and a 20% coinsurance, with the emergency coinsurance waived if you are admitted to the hospital within 24 hours. Some worldwide services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits under the Presbyterian Dual Plus (HMO D-SNP) are partially covered, offering most services—including primary care, specialists, therapies, and mental health—with no copay and a 20% coinsurance. Podiatry and non-routine chiropractic services are not covered, and routine chiropractic care is limited to 25 visits per year.
Preventive Services See details
Preventive Services are partially covered under Presbyterian Dual Plus (HMO D-SNP), featuring no copay and no coinsurance for most additional preventive services, alongside no copay and a 20% coinsurance for kidney disease education and select screenings. Non-covered services include the annual physical exam, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, and home safety modifications.
Hearing Services See details
Hearing services are partially covered by Presbyterian Dual Plus (HMO D-SNP), featuring routine hearing exams with no copay and a 20% coinsurance, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $2,000 every two years with no copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Presbyterian Dual Plus (HMO D-SNP) partially covers vision services, excluding other eye exam services from coverage. Covered routine eye exams (one per year) and eyewear—including frames, lenses, and upgrades up to a $275 annual limit—have no copays or deductibles, though a 20% coinsurance applies to routine exams and contact lenses.
Dental Services See details
Presbyterian Dual Plus (HMO D-SNP) offers partially covered dental services with no copay and a 20% coinsurance for Medicare-covered care, and no copay or coinsurance for other covered services up to a $3,000 annual maximum. Specifically, other diagnostic dental, other preventive dental, implants, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Presbyterian Dual Plus (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Presbyterian Dual Plus (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Presbyterian Dual Plus (HMO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copays and coinsurance ranging from no coinsurance up to 20%. Diabetic equipment is partially covered under this plan, which features no copay and a 20% coinsurance for therapeutic shoes and inserts, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Presbyterian Dual Plus (HMO D-SNP) with no copay and a 20% coinsurance for outpatient diagnostic tests, lab services, radiological services, and X-rays. Prior authorization is required for all radiological services.
Home Health Services See details
Home Health Services are covered under the Presbyterian Dual Plus (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Presbyterian Dual Plus (HMO D-SNP) with no copay, although only some services are covered. Cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Presbyterian Dual Plus (HMO D-SNP) covers skilled nursing facility (SNF) services with no copay and Medicare-defined coinsurance, requiring prior authorization and a prior three-day inpatient hospital stay. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Presbyterian Dual Plus (HMO D-SNP) covers other services with no copay and no coinsurance, including up to 5 acupuncture treatments per year, a chronic illness meal benefit, and a $165 over-the-counter allowance every three months. Nicotine Replacement Therapy and Naloxone are not covered under the over-the-counter benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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