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Presbyterian Healthcare Services

Plan ID: H3204-8-0

Presbyterian Senior Care Plan 1 (HMO)

2025 Presbyterian Senior Care Plan 1 (HMO) H3204008 0 is a Medicare Advantage plan . It has received a 3-out-of-5 star rating from CMS for 2025.

Learn more about Presbyterian Senior Care Plan 1 (HMO) H3204 - 008 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.

3 / 5 stars for 2025

$0.00 /mo

Monthly premium

$4250.00

Out-of-pocket maximum

Enroll online

Call to enroll

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Get personalized help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week!

Overview Icon

Plan Overview

2025 Presbyterian Senior Care Plan 1 (HMO) H3204008 0 is a HMO offered in Greater Albuquerque Area, Rio Arriba and Santa Fe by Presbyterian Healthcare Services. It has a monthly premium of $0.00.

Premium Breakdown

Standard Part B Premium

$185.00

Part B premium reduction

- $0

Monthly Plan Premium

$0.00

Total Premium:

$185.00

Note:

The standard Medicare Part B premium for 2025 is $185.00. Your premium may differ based on factors like late enrollment, income (IRMAA), or disability status. Most people enrolled in Medicare Part B are required to pay this premium.

Special needs plan type

No

Out-of-pocket maximum

$4250.00

Plan Organization:

Presbyterian Healthcare Services

Plan Type:

HMO

Location:

Greater Albuquerque Area, Rio Arriba and Santa Fe

Drugs Covered:

No

Drug Formulary:

Pharmacies:

Doctor Choice:

Doctors Link:

Deductibles

The amount you must pay each year before your plan starts to pay for covered services or drugs.

Sign up for Presbyterian Senior Care Plan 1 (HMO)

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Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week

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Drug Coverage

Presbyterian Senior Care Plan 1 (HMO) does not provide drug coverage. If drug coverage is something you need, you should consider shopping for other plans that do provide cost sharing on drugs.

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Additional Benefits

Presbyterian Senior Care Plan 1 (HMO) also provides the following benefits.

Note:

Limits, Authorizations, and Referrals may apply for the benefits below. Contact the plan for details.

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Comprehensive dental

Presbyterian Senior Care Plan 1 (HMO) does not provide this type of benefit.

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Preventive dental

Dental X-Rays
In-Network: No Coins - No Copay
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Fluoride Treatment
In-Network: No Coins - No Copay
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Oral Exams
In-Network: No Coins - No Copay
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Prophylaxis (cleaning)
In-Network: No Coins - No Copay
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Diagnostic procedures/lab services/imaging

Diagnostic radiology services
Diagnostic tests and procedures
$0 copay
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Lab services
$0 copay
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Outpatient x-rays
$25 copay
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Doctor visits

Primary
$0 copay
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Specialist
$55 copay per visit
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Emergency care/Urgent care

Emergency
$125 copay per visit (always covered)
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Urgent care
$20-55 copay per visit (always covered)
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Foot care (podiatry services)

Foot exams and treatment
$0 copay
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Routine foot care
Not covered
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Ground ambulance

All service types
$350 copay
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Hearing

Hearing aids
$499-999 copay
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Hearing aids OTC
Not covered
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Medicare-Covered Hearing Exam
$0 copay
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Fitting/evaluation
$0 copay
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Inpatient hospital coverage

All service types
$350 per day for days 1 through 5 $0 per day for days 6 through 90
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Outpatient hospital coverage

All service types
$350 copay per visit
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Optional benefits

All service types
Yes
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Medical equipment/supplies

Diabetes supplies
$0 copay
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Durable medical equipment
Prosthetics
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Medicare Part B drugs

Chemotherapy
0-20% coinsurance
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Other Part B drugs
$15 copay or 0-20% coinsurance
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Mental health services

Outpatient individual therapy visit with a psychiatrist
$0 copay
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Outpatient group therapy visit
$0 copay
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Inpatient hospital - psychiatric
$350 per day for days 1 through 5 $0 per day for days 6 through 90
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Outpatient group therapy visit with a psychiatrist
$0 copay
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Outpatient individual therapy visit
$0 copay
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Preventive care

All service types
$0 copay
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Rehabilitation services

Physical therapy and speech and language therapy visit
$25 copay
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Occupational therapy visit
$25 copay
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Skilled Nursing Facility

All service types
$0 per day for days 1 through 20 $185 per day for days 21 through 100
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Transportation

All service types
Not covered
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Vision

Contact lenses
$0 copay
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Eyeglass frames
$0 copay
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Other
Not covered
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Routine eye exam
$0 copay
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Eyeglass lenses
$0 copay
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Eyeglasses (frames and lenses)
$0 copay
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Upgrades
$0 copay
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Wellness programs (eg, fitness, nursing hotline)

All service types
Covered
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Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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Get Personalized Help from a licensed insurance agent

1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week

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Every year, Medicare evaluates plans based on a 5-star rating system.

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.

Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period

We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.

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