A non-government entity
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:
Sign up for Presbyterian Dual Plus (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Presbyterian Dual Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay coinsurance for your prescriptions. During the initial coverage phase, you will pay 25% or 26% coinsurance depending on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Presbyterian Dual Plus (HMO D-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with a 20% coinsurance for many services like primary care, emergency services, and ambulance services. Preventive services like routine exams have no copay, while others have a 20% coinsurance. This plan also covers hearing, vision, and dental services with specific coverage limits and coinsurance amounts, as well as home infusion, dialysis, and medical equipment with varying cost-sharing. Other notable benefits include coverage for home health services with no copay, over-the-counter items, and meal benefits, although some services like cardiac rehabilitation, additional home health hours, and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by the Presbyterian Dual Plus (HMO D-SNP) plan; however, additional days, non-Medicare covered stays, and upgrades for inpatient hospital acute and psychiatric care are not covered. For both acute and psychiatric care, coinsurance applies, and prior authorization is required.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services are covered by the plan. Outpatient hospital services, observation services, individual and group sessions for outpatient substance abuse, and outpatient blood services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a coinsurance of 20%.
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, including Medicare-covered ground and air ambulance services, with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 30 one-way trips per year, and other transportation services are not covered.
Emergency Services See details
Emergency Services are covered with a 20% coinsurance, and Urgently Needed Services are also covered with a 20% coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, 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, all with a 20% coinsurance. Routine chiropractic care is covered for up to 25 visits per year. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered under the Presbyterian Dual Plus (HMO D-SNP) plan. Medicare-covered preventive services have no copay, while other preventive services like Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visits have a 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, 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 1 routine hearing exam covered every year. Prescription hearing aids (all types) are covered up to $2,000 every two years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and neither are OTC hearing aids.
Vision Services See details
Vision Services include coverage for eye exams with a 20% coinsurance, routine eye exams (1 per year), and eyewear with a 20% coinsurance and a combined maximum benefit of $275 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are covered, including Medicare dental services with a 20% coinsurance. Other dental services are covered with a maximum benefit of $1800 per year, and specific services like oral exams (2 per year), dental x-rays (1 per year), prophylaxis (cleaning, 2 per year), and fluoride treatments (2 per year) are covered. Orthodontic services are covered under Diagnostic and Preventive Dental. Implant services and orthodontics are not covered.
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 coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Presbyterian Dual Plus (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Presbyterian Dual Plus (HMO D-SNP) plan, with a 20% coinsurance for durable medical equipment and prosthetic devices, and a coinsurance of 0-20% for medical supplies. Durable medical equipment for use outside the home and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Presbyterian Dual Plus (HMO D-SNP) plan. All diagnostic services, including diagnostic procedures/tests and lab services, have no copay and a coinsurance of at most 20%. Radiological services, including diagnostic and therapeutic radiological services, and outpatient X-ray services, also have no copay and 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. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
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 is based on Medicare guidelines.
Other Services See details
The Presbyterian Dual Plus (HMO D-SNP) plan's "Other Services" benefit covers over-the-counter items, with a maximum benefit of $75.00 every three months, and meal benefits for chronic illnesses. 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 are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved