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El Paso Health Medicare Advantage Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for El Paso Health Medicare Advantage Dual (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on El Paso Health Medicare Advantage Dual (HMO D-SNP) in 2025, please refer to our full plan details page.
El Paso Health Medicare Advantage Dual (HMO D-SNP) is a HMO D-SNP plan offered by El Paso County Hospital District available for enrollment in 2025 to people living in El Paso and Hudspeth counties. The overall rating for this plan is not yet available for 2025.
It's important to know that El Paso Health Medicare Advantage Dual (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:
El Paso Health Medicare Advantage Dual (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 El Paso Health Medicare Advantage Dual (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 El Paso Health Medicare Advantage Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $5.10. 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 $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 El Paso Health Medicare Advantage Dual (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, you will pay $5.10 for Part D drugs. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The El Paso Health Medicare Advantage Dual (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services require a 20% coinsurance, including outpatient, partial hospitalization, ambulance, emergency, primary care, and vision services. However, some services have no copay, such as transportation services and home health services. The plan also includes additional benefits like dental, hearing, and vision coverage. The plan provides up to $3,500 annually for dental services, coverage for hearing exams and hearing aids, and up to $400 per year for eyewear. Additionally, the plan covers a $300 quarterly allowance for over-the-counter items and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with coinsurance costs based on Medicare-defined cost sharing. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, and outpatient substance abuse services. Outpatient hospital services and observation services have a 20% coinsurance, while outpatient substance abuse services have a 20% coinsurance. Outpatient blood services are not covered.
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 by the El Paso Health Medicare Advantage Dual (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to any health-related location are covered for up to 96 one-way trips per year, with no copay.
Emergency Services See details
Emergency Services, including urgently needed services, are covered with a 20% coinsurance, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The El Paso Health Medicare Advantage Dual (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Most services have a 20% coinsurance, and routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay. Additional preventive services are also covered, but annual physical exams, health education, in-home safety assessments, medical nutrition therapy, 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, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance. Personal Emergency Response System (PERS) has a maximum plan benefit coverage amount of $360.00. Fitness Benefits are covered, with Memory Fitness offering a maximum plan benefit coverage amount of $32.00 per month. Remote Access Technologies are covered.
Hearing Services See details
Hearing Services are covered by El Paso Health Medicare Advantage Dual (HMO D-SNP), including hearing exams and prescription hearing aids, but routine hearing exams, inner ear hearing aids, outer ear hearing aids, over the ear hearing aids, and OTC hearing aids are not covered. Fitting/evaluation for hearing aids is covered for one visit per year.
Vision Services See details
The El Paso Health Medicare Advantage Dual (HMO D-SNP) plan covers vision services, including routine eye exams once per year. Eyewear is covered with a combined maximum benefit of $400.00 per year, while contact lenses and eyeglasses (lenses and frames) are also covered. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $3,500 per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, with a limit of 2 visits per year. Restorative services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are also covered. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the El Paso Health Medicare Advantage Dual (HMO D-SNP) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered by El Paso Health Medicare Advantage Dual (HMO D-SNP), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the El Paso Health Medicare Advantage Dual (HMO D-SNP) plan. All diagnostic services have no copay and coinsurance applies, while diagnostic procedures/tests and lab services have at most 20% coinsurance. Radiological services have no copay, with at most 20% coinsurance for diagnostic and therapeutic radiological services, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered and require prior authorization. The plan charges the Medicare-defined cost share for tier 1, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The El Paso Health Medicare Advantage Dual (HMO D-SNP) plan does not cover 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. The plan covers over-the-counter (OTC) items, with a maximum benefit of $300 every three months, and also covers a meal benefit for chronic illnesses.
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