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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 2026, 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 2026.
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 $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 combined Maximum Out-Of-Pocket cost of $9250.00 (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 $9250.00 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) Medicare plan features an annual prescription drug deductible of $615. This means you must pay the first $615 for your covered medications before the plan begins to pay its share of your prescription costs. Specific drug tier details, including copayments and coinsurance amounts, are not currently available for this plan. When evaluating the ProCare Advantage (HMO-POS I-SNP) plan, it is essential to consider how this $615 drug deductible fits your budget and medication needs. To get a complete picture of your potential out-of-pocket costs, you should contact the plan provider directly to verify coverage and pricing for your specific prescriptions.
Additional Benefits
The ProCare Advantage (HMO-POS I-SNP) plan offers comprehensive medical coverage featuring no copays for primary care, inpatient hospital stays, and skilled nursing facility services. However, members should expect a 20% coinsurance with no copay for most outpatient services, specialist visits, diagnostic tests, and durable medical equipment. Emergency room visits carry a $90 copay, while urgent care services require a 20% coinsurance up to $40. To support your daily wellness, this plan covers preventive dental care and home health services with no copay or coinsurance. You also get valuable allowances, such as up to $775 for eyeglasses and contacts, up to $150 every three months for prescription hearing aids, and up to 30 free one-way trips to medical appointments. Additionally, members benefit from over-the-counter item reimbursements and up to $420 annually for in-home support services.
Inpatient Hospital See details
ProCare Advantage (HMO-POS I-SNP) covers inpatient acute and psychiatric hospital services with no copay, though Medicare-defined deductibles and coins coinsurance apply and prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
ProCare Advantage (HMO-POS I-SNP) covers outpatient services with no copay and a 20% coinsurance for outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these covered outpatient services.
Partial Hospitalization See details
Partial hospitalization services are covered by ProCare Advantage (HMO-POS I-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
ProCare Advantage (HMO-POS I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering up to 30 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
ProCare Advantage (HMO-POS I-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a 20% coinsurance (up to $40) and no copay, with both cost shares counting toward the deductible and waived if admitted to the hospital within three days. While worldwide emergency services are technically covered, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered in practice.
Primary Care See details
ProCare Advantage (HMO-POS I-SNP) primary care benefits feature no copays for all covered services, with coinsurance ranging from 0% to 20% for primary care visits and 20% coinsurance for specialists, therapy, and mental health services. While telehealth and routine podiatry (up to 4 visits per year) are covered, routine chiropractic care is not covered, and opioid treatment program services are available with no copay and no coinsurance.
Preventive Services See details
ProCare Advantage (HMO-POS I-SNP) partially covers preventive services with no copays and no coinsurance for covered options like kidney disease education, glaucoma screenings, and diabetes self-management. Although annual physical exams, fitness benefits, and health education are not covered, the plan does provide up to $420 annually for mandatory in-home support services with no copay and no coinsurance.
Hearing Services See details
Hearing services are partially covered by ProCare Advantage (HMO-POS I-SNP), offering covered hearing exams with no copay and prescription hearing aids with no copay or coinsurance up to a $150 maximum every three months. Routine hearing exams, fitting and evaluation exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
ProCare Advantage (HMO-POS I-SNP) partially covers vision services with no copays, no deductibles, and a 20% coinsurance for routine eye exams and contact lenses. A combined maximum benefit of $775 is available for covered contact lenses and eyeglasses (lenses and frames), 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 ProCare Advantage (HMO-POS I-SNP), featuring select diagnostic and preventive care—including cleanings, oral exams, fluoride, and x-rays—with no copay and no coinsurance. Medicare-covered dental services require prior authorization and carry no copay and a 20% coinsurance, while other preventive services, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
ProCare Advantage (HMO-POS I-SNP) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by ProCare Advantage (HMO-POS I-SNP) with no copay and 20% coinsurance.
Medical Equipment See details
ProCare Advantage (HMO-POS I-SNP) covers durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for DME and prosthetics, and there are no restrictions on preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
ProCare Advantage (HMO-POS I-SNP) partially covers diagnostic and radiological services with no copay and a 20% coinsurance, subject to prior authorization. Covered benefits include diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays, while lab services are not covered.
Home Health Services See details
Home Health Services are covered by ProCare Advantage (HMO-POS I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
ProCare Advantage (HMO-POS I-SNP) covers cardiac rehabilitation services with no copay and a 20% coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by ProCare Advantage (HMO-POS I-SNP) with no copay and no coinsurance, and do not require a prior three-day hospital stay. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
ProCare Advantage (HMO-POS I-SNP) partially covers other services, offering over-the-counter (OTC) items via reimbursement with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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