ProCare Advantage - Diabetes Care Management (HMO-POS C-SNP)

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 2026.

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.

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.

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:

Drug Coverage

The ProCare Advantage - Diabetes Care Management (HMO-POS C-SNP) prescription drug plan has an annual drug deductible of $300. Under this plan, Tier 1 preferred generic drugs have no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs require a copay of $7.00 for a one-month supply, $14.00 for two months, and $21.00 for three months. For Tier 3 preferred brand drugs, standard pharmacy and mail-order copays are $45.00 for one month, $90.00 for two months, and $135.00 for three months. Tier 4 non-preferred drugs carry a copay of $95.00 for one month, $190.00 for two months, and $285.00 for three months. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply at standard pharmacies and standard mail order.

Additional Benefits

The ProCare Advantage - Diabetes Care Management (HMO-POS C-SNP) plan offers comprehensive coverage with no copay for primary care, physical therapy, and home health services, while specialist visits require a low $10 copay. For hospital care, inpatient stays carry a $190 daily copay for days one through five and no copay for days six through 90, while outpatient services generally require no copay and a 20% coinsurance. Emergency room visits are covered with a $90 copay, which is waived if you are admitted to the hospital within three days. Supplemental benefits include select preventive dental, hearing exams, and over-the-counter items with no copay or coinsurance, plus a vision benefit offering a $300 annual allowance for eyewear with a 20% coinsurance. Diabetic equipment is fully covered with no copay and no coinsurance, while Medicare Part B insulin drugs require a $35 copay and up to 20% coinsurance. Most diagnostic radiological services, dialysis, and durable medical equipment are also covered with no copay and a 20% coinsurance.