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 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:
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) Medicare plan features an annual drug deductible of $550. Under this plan, Tier 1 preferred generic medications are available with no copay for one-, two-, or three-month supplies at standard pharmacies and standard mail order. This provides an affordable option for essential, everyday generic medications. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, members pay a 25% coinsurance for all supply durations. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply. These coinsurance costs apply to both standard pharmacy pickups and standard mail order deliveries.
Additional Benefits
The Presbyterian Dual Plus (HMO D-SNP) offers comprehensive medical coverage with no copays for most services, though many outpatient and diagnostic services require a 20% coinsurance. Essential care like inpatient hospital stays, skilled nursing facility care, and home health services are covered with no copay and no coinsurance. Emergency care and ambulance services are also available, generally requiring a 20% coinsurance and no copay. This plan also features valuable dental, vision, and hearing benefits to help lower your out-of-pocket costs. You will pay no copay or coinsurance for preventive dental care up to $1,800 annually, hearing aids up to $2,000 every two years, and up to 30 one-way transportation trips per year. Additional perks include a fifty-dollar quarterly over-the-counter allowance and a chronic illness meal benefit with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Presbyterian Dual Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit excludes coverage for additional days, non-Medicare-covered stays, and upgrades.
Outpatient Services See details
Presbyterian Dual Plus (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, 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 coverage for this benefit.
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, while transportation services are partially covered. For transportation, there is no copay and no coinsurance for up to 30 one-way trips per year to plan-approved locations with prior authorization, but transportation to any health-related location is 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, which is 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, though worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Presbyterian Dual Plus (HMO D-SNP) covers primary care, specialist visits, therapy, and mental health services with no copay and a 20% coinsurance. While routine chiropractic care is covered for up to 25 visits per year, other chiropractic services and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Presbyterian Dual Plus (HMO D-SNP), with Medicare-covered and additional preventive services requiring no copay and no coinsurance, while kidney education and specific screenings require no copay and a 20% coinsurance. Sub-services not covered under this plan include annual physical exams, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, re-admission 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 covered by Presbyterian Dual Plus (HMO D-SNP), offering routine exams with no copay and a 20% coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 maximum every two years, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Presbyterian Dual Plus (HMO D-SNP) partially covers vision services with no deductibles, offering one routine eye exam per year with no copay and a 20% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, a 20% coinsurance for contact lenses, and a combined maximum benefit of $275 per year for frames, lenses, contact lenses, and upgrades.
Dental Services See details
Presbyterian Dual Plus (HMO D-SNP) offers partially covered dental services, featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive care up to $1,800 annually. Covered services include routine cleanings, exams, and x-rays, though implants, orthodontics, other diagnostic services, and other preventive services are not covered.
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. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Presbyterian Dual Plus (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Presbyterian Dual Plus (HMO D-SNP) covers medical equipment with no copays, though prior authorization and coinsurance requirements apply to most services. Durable medical equipment, prosthetics, and diabetic therapeutic shoes carry a 20% coinsurance, while medical supplies range from no coinsurance to 20% coinsurance; please note that 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 diagnostic tests, lab services, and radiological procedures. Prior authorization is required for all radiological services, which include diagnostic, therapeutic, and outpatient X-ray 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. Prior authorization is required to access these fully covered in-home care services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Presbyterian Dual Plus (HMO D-SNP) with no copay, but only some services are covered; standard 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
Skilled Nursing Facility (SNF) services are covered by Presbyterian Dual Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a prior three-day inpatient hospital stay are required. The benefit is partially covered, as additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Presbyterian Dual Plus (HMO D-SNP) provides covered other services with no copay and no coinsurance, including up to five acupuncture treatments annually, a chronic illness meal benefit, and a fifty-dollar quarterly over-the-counter allowance. These over-the-counter benefits are partially covered, as nicotine replacement therapy and naloxone 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