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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 2026, 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 2026.
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 $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 - Kidney Care (HMO-POS C-SNP) plan features an annual prescription drug deductible of $615. This means you will need to pay this amount out-of-pocket for your covered medications before the plan begins to pay its share. Knowing this deductible is a crucial first step in estimating your yearly healthcare expenses with this Medicare Advantage plan. Specific drug coverage tier details, including individual copays and coinsurance rates for specific medications, are currently unavailable for this plan. To understand exactly how your prescriptions will be covered after meeting the deductible, we recommend reviewing the plan's comprehensive formulary or contacting the provider directly. This ensures you have the most accurate cost estimates for your personal medication needs.
Additional Benefits
The ProCare Advantage - Kidney Care (HMO-POS C-SNP) plan offers comprehensive medical coverage featuring no copays for primary care, home health, and skilled nursing facility services. Many other essential benefits, including outpatient services, dialysis, and specialist visits, require no copay but are subject to a standard 20% coinsurance. Emergency care is accessible with a $90 copay, which is waived if you are admitted to the hospital within three days. This plan also provides valuable supplemental benefits, such as preventive dental care with no copay up to a $1,000 annual limit and vision coverage up to a $325 limit with a 20% coinsurance. Additionally, members can access up to 100 free one-way transportation trips per year to plan-approved locations and receive reimbursement for over-the-counter items with no copay. Many specialized services, diagnostic tests, and hospital stays require prior authorization to ensure covered care.
Inpatient Hospital See details
Inpatient hospital services are partially covered by ProCare Advantage - Kidney Care (HMO-POS C-SNP), offering acute and psychiatric care with no copay and Medicare-defined coinsurance and deductibles, subject to prior authorization. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
ProCare Advantage - Kidney Care (HMO-POS C-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 outpatient services.
Partial Hospitalization See details
Partial hospitalization is covered by ProCare Advantage - Kidney Care (HMO-POS C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
ProCare Advantage - Kidney Care (HMO-POS C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 100 one-way trips per year to plan-approved locations, though transportation to any other health-related location is not covered.
Emergency Services See details
ProCare Advantage - Kidney Care (HMO-POS C-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a 20% coinsurance (up to $40 per visit) and no copay, with both fees waived if admitted to the hospital within three days. 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
ProCare Advantage - Kidney Care (HMO-POS C-SNP) covers primary care, physical therapy, speech-language pathology, and opioid treatment services with no copay and no coinsurance. Other services, such as specialist visits, occupational therapy, mental health, telehealth, and routine podiatry (up to 8 visits per year), have no copay and a 20% coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services under ProCare Advantage - Kidney Care (HMO-POS C-SNP) are partially covered with no copay and no coinsurance for covered benefits such as kidney disease education, memory fitness, and diabetes self-management training. However, several services are not covered under this plan, including annual physical exams, health education, and in-home safety assessments.
Hearing Services See details
ProCare Advantage - Kidney Care (HMO-POS C-SNP) provides partial coverage for hearing services, which includes covered diagnostic hearing exams with no copay, no coinsurance, and no deductible. Routine hearing exams, fitting or evaluations, and all prescription and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by ProCare Advantage - Kidney Care (HMO-POS C-SNP) with no copays or deductibles, though a 20% coinsurance applies to routine eye exams and contact lenses. While routine eye exams (one per year) and eyewear are covered up to a $325 annual limit, other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by ProCare Advantage - Kidney Care (HMO-POS C-SNP), offering Medicare-covered dental services with no copay and a 20% coinsurance, alongside preventive services with no copay and no coinsurance up to a $1,000 annual maximum. Non-covered services include other preventive, restorative, orthodontic, endodontic, periodontic, prosthodontic, implant, adjunctive general, and oral surgery services.
Home Infusion bundled Services See details
ProCare Advantage - Kidney Care (HMO-POS C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Related Medicare Part B drugs, such as chemotherapy, radiation, and insulin, are covered with a 0% to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
ProCare Advantage - Kidney Care (HMO-POS C-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
ProCare Advantage - Kidney Care (HMO-POS C-SNP) covers durable medical equipment, prosthetic devices, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment is 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
Diagnostic and Radiological Services are partially covered under ProCare Advantage - Kidney Care (HMO-POS C-SNP), with prior authorization required for all services. Covered diagnostic services have no copay and no coinsurance, though diagnostic procedures, tests, and lab services are not covered. Covered radiological services, including X-rays, diagnostic, and therapeutic radiology, require a 20% coinsurance and no copay.
Home Health Services See details
ProCare Advantage - Kidney Care (HMO-POS C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by ProCare Advantage - Kidney Care (HMO-POS C-SNP) with no copay and require prior authorization. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered in practice and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by ProCare Advantage - Kidney Care (HMO-POS C-SNP) with no copay and no coinsurance, though prior authorization is required. Admission does not require a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
ProCare Advantage - Kidney Care (HMO-POS C-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 under this plan.
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