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Presbyterian Senior Care Extra Health Plan with Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Presbyterian Senior Care Extra Health Plan with Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Presbyterian Senior Care Extra Health Plan with Rx (HMO) in 2026, please refer to our full plan details page.
Presbyterian Senior Care Extra Health Plan with Rx (HMO) is a HMO plan offered by Presbyterian Healthcare Services available for enrollment in 2026 to people living in Counties: BER,CIB,RIO,SDV,SFE,SOC,TOR & VAL. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Presbyterian Senior Care Extra Health Plan with Rx (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Presbyterian Senior Care Extra Health Plan with Rx (HMO).
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 Senior Care Extra Health Plan with Rx (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $615.00 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 $6000.00 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 Senior Care Extra Health Plan with Rx (HMO)
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Drug Coverage
The Presbyterian Senior Care Extra Health Plan with Rx (HMO) includes an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Understanding this initial cost is a key factor when evaluating this plan for your yearly healthcare budget. Detailed prescription drug tier information, including specific copayments and coinsurance percentages, is not currently available for this plan. To determine how your specific medications are covered and what your ongoing costs will be, it is best to contact the plan provider directly.
Additional Benefits
The Presbyterian Senior Care Extra Health Plan with Rx (HMO) offers robust medical coverage with predictable cost structures, featuring no deductible for vision services and no coinsurance for many core benefits. Primary care visits, preventive services, and home health care require no copay, while specialist visits carry a $40 copay and inpatient hospital stays require a $400 copay for days one through five. Emergency room care is available with a $130 copay, and outpatient surgical services require a $350 copay. Routine dental, vision, and hearing exams are covered with no copay, though prescription hearing aids carry copays ranging from $499 to $999. Skilled nursing facility stays feature no copay for the first 20 days, and dialysis services require a 20% coinsurance. Additionally, members benefit from a $45 quarterly over-the-counter allowance and a chronic illness meal benefit, both provided with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by the Presbyterian Senior Care Extra Health Plan with Rx (HMO) with no coinsurance, requiring a $400 copay for days 1 to 5 and no copay for days 6 through 90 for both acute and psychiatric stays. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Presbyterian Senior Care Extra Health Plan with Rx (HMO) covers outpatient hospital and ambulatory surgical services with a $350 copay and no coinsurance, and observation services with a $250 copay per stay and no coinsurance. Outpatient blood services are covered with no copay or coinsurance, and while some outpatient substance abuse services are covered, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Presbyterian Senior Care Extra Health Plan with Rx (HMO) with prior authorization, requiring either no copay or a $40 copay, and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Presbyterian Senior Care Extra Health Plan with Rx (HMO), with Medicare-covered ground and air ambulance services requiring a $350 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 8 one-way trips per year to plan-approved locations under prior authorization, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by the Presbyterian Senior Care Extra Health Plan with Rx (HMO) for a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $20 to $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services feature no copay and a 20% coinsurance up to a $50,000 maximum benefit.
Primary Care See details
Presbyterian Senior Care Extra Health Plan with Rx (HMO) covers primary care, telehealth, other health professional services, and opioid treatment with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapy have a $25 copay and no coinsurance, and chiropractic care is partially covered with a $15 copay and no coinsurance for up to 25 routine visits per year (other chiropractic services are not covered). Podiatry is not covered, and while some psychiatric and mental health specialty services are covered with no copay and no coinsurance, individual and group sessions for both are not covered.
Preventive Services See details
Presbyterian Senior Care Extra Health Plan with Rx (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance (referral required), excluding sub-services such as in-home safety assessments, personal emergency response systems, weight management programs, and alternative therapies.
Hearing Services See details
Presbyterian Senior Care Extra Health Plan with Rx (HMO) covers hearing services with no copay and no coinsurance for one annual routine exam and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $499 to $999 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Presbyterian Senior Care Extra Health Plan with Rx (HMO), offering one annual routine eye exam with no coinsurance and a copay ranging from no copay to $5, though other eye exam services are not covered. Eyewear is covered with no copay and a 20% coinsurance on contact lenses up to a $265 annual limit, with no deductibles applying to any vision services.
Dental Services See details
Dental services are partially covered by the Presbyterian Senior Care Extra Health Plan with Rx (HMO), which offers Medicare-covered dental services for a $50.00 copay and no coinsurance. Routine preventive services like oral exams, cleanings, fluoride, and x-rays are covered with no copay and no coinsurance, but other diagnostic, restorative, endodontic, periodontic, prosthodontic, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Presbyterian Senior Care Extra Health Plan with Rx (HMO) with prior authorization required. Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance, other Part B drugs carry a $10 copay and no coinsurance to 20% coinsurance, and chemotherapy drugs require a copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Presbyterian Senior Care Extra Health Plan with Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Presbyterian Senior Care Extra Health Plan with Rx (HMO) covers medical equipment with no copays, including durable medical equipment and prosthetic devices with a 20% coinsurance, and medical supplies with no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with no copay, offering therapeutic shoes and inserts with a 20% coinsurance, while diabetic supplies are not covered. Prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Presbyterian Senior Care Extra Health Plan with Rx (HMO) diagnostic services are partially covered with no copay and no coinsurance, but diagnostic procedures, tests, and lab services are not covered. Covered radiological services require prior authorization and include outpatient X-rays for a $30 copay and no coinsurance, diagnostic radiological services with a minimum $290 copay and no coinsurance, and therapeutic radiological services with a 20% coinsurance and no copay.
Home Health Services See details
Home health services are covered under the Presbyterian Senior Care Extra Health Plan with Rx (HMO) with no copay and no coinsurance. Prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Presbyterian Senior Care Extra Health Plan with Rx (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, although cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
The Presbyterian Senior Care Extra Health Plan with Rx (HMO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $195 daily copay for days 21 through 100, though additional days beyond the standard 100-day limit are not covered.
Other Services See details
Presbyterian Senior Care Extra Health Plan with Rx (HMO) partially covers other services, offering acupuncture for a $25 copay and no coinsurance for up to 25 treatments annually. Additionally, a chronic illness meal benefit and a $45 quarterly over-the-counter allowance are provided with no copay and no coinsurance, though nicotine replacement therapy and naloxone are not covered.
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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.
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