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ProCare Advantage - Kidney Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ProCare Advantage - Kidney Care (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ProCare Advantage - Kidney Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
ProCare Advantage - Kidney Care (HMO-POS C-SNP) is a HMO-POS C-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 - Kidney Care (HMO-POS C-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 - Kidney Care (HMO-POS C-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 - Kidney Care (HMO-POS C-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 - Kidney Care (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.10. 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 - Kidney Care (HMO-POS C-SNP) plan has a $590 deductible for prescription drugs. After the deductible, the plan will cover your drug costs until your total drug costs reach $2,000. If you qualify for the low-income subsidy (LIS), also known as "Extra Help", you may have a reduced premium. With LIS, your monthly Part D premium is $17.10.
Additional Benefits
The ProCare Advantage - Kidney Care (HMO-POS C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with a 20% coinsurance for many outpatient services. Emergency services have a $90 copay, while primary care and other specialist services have a 20% coinsurance. This plan also includes coverage for ambulance, home infusion, and dialysis services with varying cost-sharing. Vision and dental services are limited, with a 20% coinsurance for eye exams and a $1,000 annual maximum for dental services, but no coverage for things like hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but cost sharing details like coinsurance and deductible amounts are not provided. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric inpatient hospital services are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services, all with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for 100 one-way trips per year using rideshares, buses, subways, or vans. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the ProCare Advantage - Kidney Care (HMO-POS C-SNP) plan with a $90 copay and no coinsurance. Urgently Needed Services are covered with a 20% coinsurance and no copay, while Worldwide Emergency Services are not covered.
Primary Care See details
The ProCare Advantage - Kidney Care (HMO-POS C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional Services, Psychiatric Services, and Additional Telehealth Benefits have a 20% coinsurance. Occupational Therapy Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Routine Foot Care also have a 20% coinsurance. Physical Therapy and Speech-Language Pathology Services are covered with no coinsurance.
Preventive Services See details
Preventive Services, including Medicare-covered services, are covered. However, annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services are covered, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are limited to one per year. Eyewear, including contact lenses and eyeglasses (lenses and frames), also has a 20% coinsurance, with a combined maximum benefit of $300 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a $1,000 maximum benefit per year. Oral exams are covered for up to 2 visits per year, while dental x-rays are covered for 2 x-rays per year. Prophylaxis (cleaning) is covered for up to 2 visits per year, and fluoride treatment is covered every six months for one visit. 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the ProCare Advantage - Kidney Care (HMO-POS C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance, all with no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the ProCare Advantage - Kidney Care (HMO-POS C-SNP) plan. Diagnostic procedures, tests, and lab services are not covered. Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have no copay, but each have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the ProCare Advantage - Kidney Care (HMO-POS C-SNP) plan with no copay and no coinsurance, but prior 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 by the ProCare Advantage - Kidney Care (HMO-POS C-SNP) plan. Prior authorization is required for this service.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the cost sharing is the same as Original Medicare.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, but does not cover 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. This plan does not offer Nicotine Replacement Therapy (NRT) or Naloxone coverage as an OTC benefit, and not all drugs on the CMS OTC list are covered.
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