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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 2026, 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 2026.
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 $4.80. 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 $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 $8600.00 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 features an annual drug deductible of $615. Under the initial coverage phase, members using standard pharmacies or standard mail order will pay a 22% coinsurance for Tier 1 preferred generic drugs. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, standard pharmacy and mail order services require a 25% coinsurance. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply through standard pharmacy and mail order services. Notably, Tier 6 supplemental drugs are covered with no copay for up to a three-month supply under standard pharmacy and mail order options.
Additional Benefits
The El Paso Health Medicare Advantage Dual (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays for most services, though many outpatient and specialist visits are subject to a 20% coinsurance. Key medical services, including inpatient hospital stays, home health care, and skilled nursing facility stays, are covered with no copay and no coinsurance. For outpatient care, diagnostic tests, emergency services, and durable medical equipment, members will generally pay no copay alongside a 20% coinsurance. Additionally, this plan provides valuable supplemental benefits with no copay and no coinsurance, including up to $3,000 annually for dental care and $400 annually for vision hardware. Members also receive a $2,000 hearing benefit every two years, up to 96 free one-way trips to healthcare appointments per year, and a $225 over-the-counter quarterly allowance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by El Paso Health Medicare Advantage Dual (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) covers outpatient services with no copay, subject to a 20% coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) covers partial hospitalization benefits with no copay and a 20% coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by El Paso Health Medicare Advantage Dual (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services under prior authorization. Additionally, members receive up to 96 one-way trips per year to any health-related location with no copay and no coinsurance.
Emergency Services See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within 24 hours. For worldwide emergency services, some services are covered but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and 20% coinsurance. For chiropractic care, some services are covered but routine and other chiropractic services are not covered, while routine podiatry is limited to 10 visits per year.
Preventive Services See details
Preventive Services are partially covered by El Paso Health Medicare Advantage Dual (HMO D-SNP), featuring no copay and no coinsurance for Medicare-covered zero-dollar and additional preventive services, and no copay with 20% coinsurance for kidney disease education and select screenings. However, several benefits are not covered, including annual physical exams, health education, in-home safety assessments, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are partially covered by El Paso Health Medicare Advantage Dual (HMO D-SNP) with no copay, no coinsurance, and no deductible, up to a $2,000 maximum benefit every two years. While routine hearing exams and fitting evaluations are covered, over-the-counter hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by El Paso Health Medicare Advantage Dual (HMO D-SNP) with no copay and no coinsurance. The plan covers one routine eye exam per year and provides a $400 annual maximum for contact lenses and eyeglasses, while other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under El Paso Health Medicare Advantage Dual (HMO D-SNP) with no copay and no coinsurance up to a $3,000 annual maximum. Covered options include exams, cleanings, and restorative care, but other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) covers medical equipment—including durable medical equipment, prosthetics, medical supplies, and diabetic services—with no copay and a 20% coinsurance. Prior authorization is required for these covered services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance for diagnostic procedures, lab services, radiological services, and outpatient X-rays. Prior authorization is required for all radiological services.
Home Health Services See details
Home Health Services are covered under the El Paso Health Medicare Advantage Dual (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay, though prior authorization is required. However, key sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation—are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by El Paso Health Medicare Advantage Dual (HMO D-SNP) with no copay and no coinsurance, requiring prior authorization and a prior inpatient hospital stay of at least three days. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
El Paso Health Medicare Advantage Dual (HMO D-SNP) offers partial coverage for other services, featuring a chronic illness meal benefit and up to $225 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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