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ProCare Advantage (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ProCare Advantage (HMO-POS I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ProCare Advantage (HMO-POS I-SNP) in 2025, please refer to our full plan details page.
ProCare Advantage (HMO-POS I-SNP) is a HMO-POS I-SNP plan offered by First Sacramento Capital Funding LLC available for enrollment in 2025 to people living in Texas (partial). This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that ProCare Advantage (HMO-POS I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
ProCare Advantage (HMO-POS I-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 ProCare Advantage (HMO-POS I-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 ProCare Advantage (HMO-POS I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. 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 combined Maximum Out-Of-Pocket cost of $9350.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9350.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 ProCare Advantage (HMO-POS I-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you pay the costs for your drugs, but the specific costs for each drug tier are not listed in the provided information. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, with a monthly Part D premium of $18.30.
Additional Benefits
The ProCare Advantage (HMO-POS I-SNP) plan offers a range of benefits with varying cost-sharing. You'll have no copay for ambulance services, home health services, and Medicare-covered preventive services. Many services, including outpatient, primary care, hearing, vision, and dental, have a 20% coinsurance. This plan provides coverage for emergency and outpatient services, with a $90 copay for emergencies and 20% coinsurance for urgently needed services. The plan also offers additional benefits like over-the-counter items up to $30 per month. However, some services like cardiac rehabilitation, and additional days for inpatient care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with prior authorization, but the specific costs for coinsurance and deductibles are not detailed. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services and observation services, both of which have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and outpatient substance abuse services are also covered, with a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the ProCare Advantage (HMO-POS I-SNP) plan, but requires prior authorization, and has a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance Services are covered under the ProCare Advantage (HMO-POS I-SNP) plan, with no copay and a 20% coinsurance for both ground and air ambulance services. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the ProCare Advantage (HMO-POS I-SNP) plan, with a $90 copay and no coinsurance. Urgently Needed Services are covered with 20% coinsurance and no copay, and Worldwide Emergency Services are not covered.
Primary Care See details
The ProCare Advantage (HMO-POS I-SNP) plan covers Primary Care Physician Services with a coinsurance of 0% to 20%. Chiropractic Services are covered with a 20% coinsurance, but routine care is not covered. Occupational Therapy Services and Physical Therapy/Speech-Language Pathology Services are covered with a 20% coinsurance. Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, and Additional Telehealth Benefits are covered with a 20% coinsurance. Podiatry Services and Other Health Care Professional benefits are covered with a 20% coinsurance.
Preventive Services See details
The ProCare Advantage (HMO-POS I-SNP) plan covers Medicare-covered preventive services with no copay, as well as additional preventive services including In-Home Support Services with a maximum plan benefit coverage amount of $420.00 per year. Annual physical exams, health education, in-home safety assessments, Personal Emergency Response Systems (PERS), medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services are partially covered by the ProCare Advantage (HMO-POS I-SNP) plan. Hearing exams have a coinsurance of at most 20%, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are limited to one per year. Eyewear also has a 20% coinsurance, with a combined maximum of $175 per year for contact lenses, eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The ProCare Advantage (HMO-POS I-SNP) plan covers Medicare dental services with 20% coinsurance and other dental services including oral exams (2 per year), dental x-rays (2, periodicity described in notes), other diagnostic dental services, prophylaxis (cleaning) (2 per year), and fluoride treatment (1 every six months). However, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the ProCare Advantage (HMO-POS I-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay and between 0% and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the ProCare Advantage (HMO-POS I-SNP) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the ProCare Advantage (HMO-POS I-SNP) plan. Durable Medical Equipment has a 20% coinsurance, and requires authorization. Prosthetic devices, and diabetic supplies and therapeutic shoes/inserts have a 20% coinsurance. Medical supplies 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 ProCare Advantage (HMO-POS I-SNP) plan. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the ProCare Advantage (HMO-POS I-SNP) plan with no copay and no coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the ProCare Advantage (HMO-POS I-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C. The plan does not cover additional days beyond Medicare-covered SNF and non-Medicare-covered stays.
Other Services See details
Other Services for ProCare Advantage (HMO-POS I-SNP) includes coverage for Over-the-Counter (OTC) items up to $30.00 per month, but Acupuncture, Meal Benefit, 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 are not covered.
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