A non-government entity
El Paso Health Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for El Paso Health Giveback (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 Giveback (HMO) in 2026, please refer to our full plan details page.
El Paso Health Giveback (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 Giveback (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 Giveback (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 Giveback (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 $120.00. 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 $8450.00 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 Giveback (HMO) plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental medications filled at standard pharmacies or through standard mail order. This coverage structure helps minimize out-of-pocket costs for common maintenance prescriptions. For higher-tier medications, cost-sharing is applied as a percentage of the drug cost. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs have a 27% coinsurance. Specialty medications in Tier 5 require a 25% coinsurance for a one-month supply at standard retail pharmacies or standard mail order.
Additional Benefits
The El Paso Health Giveback (HMO) offers comprehensive healthcare coverage with no copay for primary care visits and preventive services. For inpatient hospital stays, members pay a $400 daily copay for the first five days and no copay for days six through ninety, while specialist visits require a $35 copay. Emergency services are covered with a $115 copay, which is waived if you are admitted, and urgent care ranges from no copay to a $40 copay. This plan also includes essential dental, vision, and hearing benefits, featuring no copay for routine dental care up to a $750 annual limit and no copay for eyewear up to a $200 annual limit. Routine hearing exams carry a $30 copay, and home health services are available with no copay or coinsurance. For medical equipment and dialysis services, members will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by El Paso Health Giveback (HMO), requiring prior authorization and featuring no coinsurance. Covered acute and psychiatric stays require a $400 daily copay for days 1 through 5 and no copay for days 6 through 90, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
El Paso Health Giveback (HMO) covers outpatient services with no coinsurance, featuring a $0 to $500 copay for outpatient hospital services and a $400 copay for observation and ambulatory surgical center services. Outpatient substance abuse group and individual sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
El Paso Health Giveback (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
El Paso Health Giveback (HMO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
El Paso Health Giveback (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within one day, and urgently needed services with no copay to a $40 copay and no coinsurance. 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 Giveback (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, occupational therapy, and mental health services require a $35 copay and no coinsurance. Physical therapy and telehealth services are also covered with copays ranging from no copay to $50 and no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the El Paso Health Giveback (HMO) plan with no copay and no coinsurance for covered services, including Medicare-covered preventive care, kidney disease education, memory fitness, and remote access technologies. However, the plan does not cover annual physical exams, health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, or counseling services.
Hearing Services See details
Hearing Services offered by the El Paso Health Giveback (HMO) are partially covered, featuring a $30 copay and no coinsurance for routine hearing exams, with no deductible and up to three annual fitting evaluations. Prescription hearing aids require a copay of $525 to $1,000 with no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
El Paso Health Giveback (HMO) covers vision services, offering routine eye exams with a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 annual limit for contact lenses and eyeglasses, though separate eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
El Paso Health Giveback (HMO) provides partially covered dental services with a $35.00 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $750.00 annual maximum. While many services like exams, cleanings, and x-rays are covered, other preventive dental services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
El Paso Health Giveback (HMO) covers Home Infusion bundled Services with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy and other Part B drugs require no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the El Paso Health Giveback (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
El Paso Health Giveback (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
El Paso Health Giveback (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and an $85 copay for diagnostic procedures and tests. Radiological services require prior authorization and include diagnostic radiology for a $75 copay, therapeutic radiology with a 20% coinsurance, and outpatient X-rays with no copay.
Home Health Services See details
Home Health Services are covered by El Paso Health Giveback (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
El Paso Health Giveback (HMO) covers Cardiac Rehabilitation Services with no coinsurance, but prior authorization is required. Some services are covered, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice, carrying copayments of $20 to $25.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by El Paso Health Giveback (HMO) with no coinsurance, though prior authorization and a three-day inpatient hospital stay are required before admission. There is no copay for days 1 through 20, followed by a $214 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Other services are partially covered by El Paso Health Giveback (HMO), which offers a chronic illness meal benefit with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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