A non-government entity
El Paso Health Total (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for El Paso Health Total (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on El Paso Health Total (HMO) in 2026, please refer to our full plan details page.
El Paso Health Total (HMO) is a HMO plan offered by El Paso County Hospital District available for enrollment in 2026 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 Total (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 El Paso Health Total (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 El Paso Health Total (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.
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 $425.00 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 $4000.00 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 Total (HMO) plan features an annual drug deductible of $425. Under this plan, you will pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Supplemental Drugs) when using standard pharmacies or standard mail order services. This makes essential and supplemental medications highly affordable for members looking to minimize out-of-pocket costs. For Tier 3 (Preferred Brand) drugs, standard pharmacy and mail order copays are $35 for a 1-month supply, $70 for a 2-month supply, and $105 for a 3-month supply. Higher-tier medications require coinsurance, with Tier 4 (Non-Preferred Drugs) carrying a 30% coinsurance and Tier 5 (Specialty Tier) requiring 28% coinsurance for a 1-month supply. These clear cost-sharing tiers help you easily budget for your prescription needs.
Additional Benefits
The El Paso Health Total (HMO) plan offers robust core medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits and Medicare-covered preventive services. For inpatient hospital stays, members pay a $100 daily copay for the first five days and no copay for days six through 90, while specialist visits and emergency room services require a $25 copay and a $140 copay, respectively. Outpatient hospital services range from no copay up to a $150 copay, and diagnostic lab work and home health services are available with no copays or coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $1,500 annual limit with no copay for most preventive and comprehensive services. Routine eye and hearing exams are available for a $25 copay, with additional allowances of up to $200 annually for eyewear and a $45 quarterly over-the-counter item allowance at no cost. For specialized care, durable medical equipment and dialysis services require a 20% coinsurance with no copay, while skilled nursing facility stays require a $20 daily copay for the first 20 days.
Inpatient Hospital See details
El Paso Health Total (HMO) provides partially covered inpatient hospital acute and psychiatric services with no coinsurance, requiring a $100 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and additional days, non-Medicare-covered stays, and acute upgrades are not covered.
Outpatient Services See details
El Paso Health Total (HMO) covers outpatient services with no coinsurance, featuring outpatient hospital services with a $0 to $150 copay and observation services with a $100 copay per stay. Ambulatory surgical center services require a $115 copay with no coinsurance, outpatient substance abuse sessions have a $25 copay with no coinsurance, and blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
El Paso Health Total (HMO) covers partial hospitalization services with a $25.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under El Paso Health Total (HMO), featuring a $300 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Transportation benefits are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by El Paso Health Total (HMO) with a $140 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay to a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Primary care benefits are partially covered by El Paso Health Total (HMO), as chiropractic and podiatry services are not covered. Covered primary care physician visits have no copay and no coinsurance, while specialists, occupational therapy, and mental health services require a $25 copay and no coinsurance, and physical therapy has a $25 to $30 copay and no coinsurance.
Preventive Services See details
Preventive services are covered by El Paso Health Total (HMO) with no copay and no coinsurance for Medicare-covered preventive services, kidney disease education, and select screenings. This benefit is only partially covered, excluding annual physical exams and various supplemental services like health education, in-home safety assessments, and personal emergency response systems, while covering memory fitness up to $32 per month and remote access technologies.
Hearing Services See details
Hearing services are partially covered by El Paso Health Total (HMO), offering routine hearing exams for a $25 copay and no coinsurance, and covered prescription hearing aids for a $525 to $1,000 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
El Paso Health Total (HMO) partially covers vision services, providing one routine eye exam per year for a $25 copay and no coinsurance, with no deductible. Eyewear is also partially covered with no copay, no coinsurance, and no deductible up to a $200 annual limit for contact lenses and eyeglasses, but other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by El Paso Health Total (HMO), featuring a $1,500 annual maximum with no copay and no coinsurance for most preventive and comprehensive dental care. Medicare-covered dental services require a $25 copay and no coinsurance, but orthodontics, implants, maxillofacial prosthetics, and other preventive dental services are not covered.
Home Infusion bundled Services See details
El Paso Health Total (HMO) covers Home Infusion bundled Services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy and other drugs carry no copay and no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by El Paso Health Total (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is partially covered by El Paso Health Total (HMO) with no copay and a 20% coinsurance, subject to prior authorization. While durable medical equipment, prosthetics, medical supplies, and diabetic supplies are covered, diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
El Paso Health Total (HMO) covers diagnostic and radiological services, offering lab services with no copay and no coinsurance, and outpatient X-rays with no copay. Diagnostic tests require a $90 copay with no coinsurance, while diagnostic radiological services have a minimum $165 copay and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by El Paso Health Total (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by El Paso Health Total (HMO) with a $25 copay and no coinsurance, though prior authorization is required. While 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.
Skilled Nursing Facility (SNF) See details
El Paso Health Total (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, although prior authorization is required. You will pay a $20 daily copay for days 1 through 20 and a $214 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
El Paso Health Total (HMO) partially covers other services, offering a meal benefit for chronic illness and an over-the-counter item allowance of $45 every three months with no copay and no coinsurance. Acupuncture and other additional services are not covered under this plan benefit.
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