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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 $8500.00 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) prescription drug plan has an annual drug deductible of $550. Under this plan, Tier 1 preferred generic drugs are highly affordable, requiring no copay for one-month, two-month, or three-month supplies filled at standard retail pharmacies or through standard mail order. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, members are responsible for a 25% coinsurance across all available supply lengths. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply through standard retail and mail-order options.
Additional Benefits
The Presbyterian Dual Plus (HMO D-SNP) plan offers comprehensive medical coverage with no copays for most services, though many outpatient and specialty services require a 20% coinsurance. Key benefits such as inpatient hospital stays, skilled nursing facility care, home health, and most preventive care are fully covered with no copay and no coinsurance. For outpatient care, primary and specialist visits, emergency services, and diagnostic tests, you will pay no copay but are responsible for a 20% coinsurance. Specialty benefits under this plan include partial coverage for vision and hearing, which feature no copays but require a 20% coinsurance for routine exams alongside specific coverage limits for glasses and hearing aids. However, it is important to note that routine dental services, diabetic supplies, and over-the-counter items are not covered. Other supportive services like home infusion and limited acupuncture are available with no copay and no coinsurance.
Inpatient Hospital See details
Presbyterian Dual Plus (HMO D-SNP) inpatient hospital benefits are partially covered, offering acute and psychiatric stays with no copay and no coinsurance, subject to prior authorization. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Presbyterian Dual Plus (HMO D-SNP) covers outpatient services with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for ambulatory surgical center, outpatient hospital, and observation services.
Partial Hospitalization See details
Partial hospitalization is covered under the Presbyterian Dual Plus (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Presbyterian Dual Plus (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, and this cost is not waived if you are admitted to the hospital. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Presbyterian Dual Plus (HMO D-SNP) covers emergency services with a 20% coinsurance (up to $115 per visit) and no copay, with the coinsurance waived if you are admitted to the hospital within 24 hours. Urgently needed services are also covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Presbyterian Dual Plus (HMO D-SNP) covers primary care, specialist, therapy, telehealth, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance. Chiropractic services are partially covered with no copay and 20% coinsurance for up to 25 routine visits per year, while other chiropractic services and podiatry services are not covered.
Preventive Services See details
Presbyterian Dual Plus (HMO D-SNP) covers preventive services with no copay and no coinsurance for most additional services, although some benefits like annual physical exams and in-home safety assessments are not covered. While many preventive benefits have no cost, certain covered screenings and educational services, including kidney disease education and glaucoma screenings, require no copay but have a 20% coinsurance.
Hearing Services See details
Presbyterian Dual Plus (HMO D-SNP) provides hearing services with no copay for exams and prescription hearing aids, though routine hearing exams carry a 20% coinsurance. Prescription hearing aids are covered up to $2,000 every three years with no coinsurance, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Presbyterian Dual Plus (HMO D-SNP) with no copays or deductibles, featuring a 20% coinsurance for routine eye exams and contact lenses. Routine eye exams are limited to one per year, other eye exam services are not covered, and the plan offers a $275 annual maximum benefit for eyewear.
Dental Services See details
Dental services are partially covered by Presbyterian Dual Plus (HMO D-SNP), which only covers Medicare-covered dental services with no copay and a 20% coinsurance. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, fluoride treatments, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Presbyterian Dual Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization and step therapy are required. Medicare Part B drugs for these services, including chemotherapy and insulin, have coinsurance ranging from no coinsurance up to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Presbyterian Dual Plus (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Presbyterian Dual Plus (HMO D-SNP) partially covers medical equipment with no copays, but a 20% coinsurance applies to durable medical equipment, prosthetics, and diabetic therapeutic shoes, while medical supplies range from no coinsurance to 20% coinsurance. This benefit is considered partially covered because diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Presbyterian Dual Plus (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance for all laboratory tests, diagnostic procedures, and imaging. Prior authorization is required for radiological services, which include outpatient X-rays as well as diagnostic and therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Presbyterian Dual Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Presbyterian Dual Plus (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, but a 20% coinsurance applies to cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Presbyterian Dual Plus (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and a three-day inpatient hospital stay are required prior to admission. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Presbyterian Dual Plus (HMO D-SNP) partially covers other services, providing acupuncture (limited to 5 treatments per year) and meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items and other supplemental services are not covered under this benefit.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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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