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ProCare Advantage - Diabetes Care Management (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ProCare Advantage - Diabetes Care Management (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 - Diabetes Care Management (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
ProCare Advantage - Diabetes Care Management (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 - Diabetes Care Management (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 - Diabetes Care Management (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 - Diabetes Care Management (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 - Diabetes Care Management (HMO-POS C-SNP), 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.
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 $300.00 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 $3100.00 (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 $3100.00 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 - Diabetes Care Management (HMO-POS C-SNP) plan has a $300 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and whether you use a preferred or standard pharmacy. For example, you will pay a $7 copay for preferred generic drugs at a standard or mail pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), you will pay $0.00 for Part D drugs.
Additional Benefits
The ProCare Advantage plan offers a range of benefits, including inpatient hospital stays with a $225 copay for the first 5 days and no copay for days 6-90. Outpatient services, partial hospitalization, ambulance services, and emergency services are covered, with varying copays and coinsurance depending on the service. The plan includes coverage for primary care, preventive services, and hearing services, with coinsurance for some services and no copay for others. Vision and dental services are also included, with coinsurance for eye exams, eyewear, and Medicare dental services. Home infusion, dialysis, medical equipment, diagnostic, and radiological services are covered with copays or coinsurance. Home health, cardiac rehabilitation, and skilled nursing facility services are also available with no copay. Other benefits like Over-the-Counter (OTC) Items are provided, but some services, such as acupuncture and private duty nursing, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with prior authorization. For days 1-5, the copay is $225, and for days 6-90, there is no copay. Additional days for inpatient hospital, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, both with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with a coinsurance of 20% for Individual and Group Sessions for Outpatient Substance Abuse. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the ProCare Advantage - Diabetes Care Management (HMO-POS C-SNP) plan. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for ambulance services. Both ground and air ambulance services have a 20% coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered with a $90 copay, and there is no coinsurance. Urgently Needed Services are covered with 20% coinsurance and no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services are covered with 20% coinsurance, and Routine Chiropractic Care is not covered. Physician Specialist Services have a $20 copay. Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance. Additional Telehealth Benefits have a 20% coinsurance.
Preventive Services See details
Preventive Services are covered, with specific services like annual physical exams, health education, in-home safety assessments, and others not covered. Some services, like glaucoma screening, diabetes self-management training, and others are covered.
Hearing Services See details
Hearing Services are partially covered under the ProCare Advantage plan. Hearing exams are covered with a 20% coinsurance, and there is no deductible, but routine hearing exams and fitting/evaluation for hearing aids are not covered. Prescription and OTC hearing aids are 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 once per year. Eyewear, including contact lenses, has a 20% coinsurance, with a combined maximum benefit of $300 every year, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a 20% coinsurance, oral exams (2 per year), dental x-rays (2), other diagnostic dental services, prophylaxis (cleaning) (2 per year), and fluoride treatment (1 every six months). Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including insulin and other Medicare Part B drugs. Insulin has a $35 copay, with coinsurance ranging from 0% to 20%, while other Medicare Part B drugs have coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the ProCare Advantage plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the ProCare Advantage plan, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Medical Supplies and Diabetic Equipment are also covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the ProCare Advantage plan, with no copay for all diagnostic services and no copay for all radiological services. Diagnostic procedures, tests, and lab services are not covered, but all radiological services are covered with a coinsurance of at most 20% for diagnostic, therapeutic, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the ProCare Advantage 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 covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and there is coinsurance for some services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and coinsurance information is available in the plan details.
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 offers Over-The-Counter (OTC) Items as a supplemental benefit under Part C, but does not cover all drugs on the CMS OTC list.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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