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inurance organization provider

First Sacramento Capital Funding LLC

Plan ID: H3467-1-0

ProCare Advantage (HMO-POS I-SNP)

2025 ProCare Advantage (HMO-POS I-SNP) H3467 — 001 — 0 is a Medicare Advantage plan with drug coverage. It has received a 3-out-of-5 star rating from CMS for 2025.

Learn more about ProCare Advantage (HMO-POS I-SNP) H3467 - 001 - 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

$18.30 /mo

Monthly premium

$590.00

Drug deductible

$9350.00

Out-of-pocket maximum

Enroll online

Call to enroll

OR

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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!

OverviewBenefits & CostsDrug CoverageAdditional Benefits
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Plan Overview

2025 ProCare Advantage (HMO-POS I-SNP) H3467 — 001 — 0 is a HMO-POS I-SNP offered in Texas (partial) by First Sacramento Capital Funding LLC. It has a monthly premium of $18.30.

Important:

2025 ProCare Advantage (HMO-POS I-SNP) H3467 — 001 — 0 is a Institutional Special Needs Type plan. You can only enroll in this plan if you meet specific criteria.

Premium Breakdown

Standard Part B Premium

$185.00

Part B premium reduction

- $0

Monthly Plan Premium

$18.30

Total Premium:

$203.30

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

Yes

Out-of-pocket maximum

$9350.00

Conditions Covered

None

Plan Organization:

First Sacramento Capital Funding LLC

Plan Type:

HMO-POS I-SNP

Location:

Texas (partial)

Drugs Covered:

Yes

Drug Formulary:

Formulary Link

Pharmacies:

Pharmacies Link

Doctor Choice:

Doctors Link:

Doctors Link

Deductibles

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

Drug deductible

$590

Note:

This plan does not charge an annual deductible for all drugs. The $590.00 annual deductible only applies to drugs in certain tiers.

Sign up for ProCare Advantage (HMO-POS I-SNP)

Enroll online

Call to enroll

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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

Drug Coverage Icon

Drug Coverage

ProCare Advantage (HMO-POS I-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Benefit Type

Defined Standard

Prescription drug deductible

$590.00

Part D Premium Reduction

This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.

Part D

LIS Full

$18.30

$18.30

Initial Coverage Phase

After you pay your $590.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2000.00. Once you reach that amount, you will enter the next coverage phase.

30 Days
60 Days
90 Days

Tier

Preferred Pharmacy

Standard Pharmacy

Preferred Mail

Standard Mail

1. Preferred Generic

-

-

-

-

2. Standard Generic

-

-

-

-

3. Preferred Brand

-

-

-

-

4. Non-Preferred Drug

-

-

-

-

5. Specialty Tier

-

-

-

-

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.

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Additional Benefits

ProCare Advantage (HMO-POS I-SNP) also provides the following benefits.

Note:

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

Additional Coverage Icon

Comprehensive dental

ProCare Advantage (HMO-POS I-SNP) does not provide this type of benefit.

Additional Coverage Icon

Preventive dental

Dental X-Rays
In-Network: No Coins - No Copay
Limit Icon
Fluoride Treatment
In-Network: No Coins - No Copay
Limit Icon
Oral Exams
In-Network: No Coins - No Copay
Limit Icon
Other Diagnostic Dental Services
In-Network: No Coins - No Copay
Limit Icon
Prophylaxis (cleaning)
In-Network: No Coins - No Copay
Limit Icon
Additional Coverage Icon

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures
In-Network: 20% coinsurance
Limit IconExclamation Icon
Lab services
In-Network: $0 copay
Limit IconExclamation Icon
Outpatient x-rays
In-Network: 20% coinsurance
Limit IconExclamation Icon
Diagnostic radiology services
Additional Coverage Icon

Doctor visits

Specialist
In-Network: 20% coinsurance per visit
Limit IconExclamation Icon
Out-Of-Network: 20% coinsurance per visit
Limit IconExclamation Icon
Primary
In-Network: 0-20% coinsurance per visit
Limit Icon
Additional Coverage Icon

Emergency care/Urgent care

Emergency
$90 copay per visit (always covered)
Limit Icon
Urgent care
20% coinsurance per visit (always covered)
Limit Icon
Additional Coverage Icon

Foot care (podiatry services)

Foot exams and treatment
In-Network: 20% coinsurance
Limit Icon
Routine foot care
In-Network: $0 copay
Limit Icon
Additional Coverage Icon

Ground ambulance

All service types
In-Network: 20% coinsurance
Limit Icon
Additional Coverage Icon

Hearing

Fitting/evaluation
Not covered
Limit Icon
Hearing aids - inner ear
Not covered
Limit Icon
Hearing aids OTC
Not covered
Limit Icon
Medicare-Covered Hearing Exam
In-Network: 20% coinsurance
Limit Icon
Hearing aids - outer ear
Not covered
Limit Icon
Hearing aids - over the ear
Not covered
Limit Icon
Additional Coverage Icon

Inpatient hospital coverage

All service types
In-Network: Coming soon
Limit IconExclamation Icon
Out-Of-Network: Not Applicable
Limit IconExclamation Icon
Additional Coverage Icon

Outpatient hospital coverage

All service types
In-Network: 20% coinsurance per visit
Limit IconExclamation Icon
Additional Coverage Icon

Optional benefits

All service types
No
Limit Icon
Additional Coverage Icon

Medical equipment/supplies

Prosthetics
Diabetes supplies
In-Network: 20% coinsurance per item
Limit Icon
Durable medical equipment
Additional Coverage Icon

Medicare Part B drugs

Chemotherapy
In-Network: 0-20% coinsurance
Limit IconExclamation Icon
Other Part B drugs
In-Network: 0-20% coinsurance
Limit IconExclamation Icon
Additional Coverage Icon

Mental health services

Inpatient hospital - psychiatric
In-Network: Coming soon
Limit IconExclamation Icon
Out-Of-Network: Not Applicable
Limit IconExclamation Icon
Outpatient individual therapy visit with a psychiatrist
In-Network: 20% coinsurance
Limit IconExclamation Icon
Outpatient individual therapy visit
In-Network: 20% coinsurance
Limit IconExclamation Icon
Outpatient group therapy visit
In-Network: 20% coinsurance
Limit IconExclamation Icon
Outpatient group therapy visit with a psychiatrist
In-Network: 20% coinsurance
Limit IconExclamation Icon
Additional Coverage Icon

Preventive care

All service types
In-Network: $0 copay
Limit Icon
Additional Coverage Icon

Rehabilitation services

Physical therapy and speech and language therapy visit
In-Network: 20% coinsurance
Limit IconExclamation Icon
Occupational therapy visit
In-Network: 20% coinsurance
Limit IconExclamation Icon
Additional Coverage Icon

Skilled Nursing Facility

All service types
In-Network: Coming soon
Limit IconExclamation Icon
Out-Of-Network: Not Applicable
Limit IconExclamation Icon
Additional Coverage Icon

Transportation

All service types
Not covered
Limit Icon
Additional Coverage Icon

Vision

Eyeglass frames
Not covered
Limit Icon
Eyeglass lenses
Not covered
Limit Icon
Eyeglasses (frames and lenses)
In-Network: $0 copay
Limit Icon
Other
Not covered
Limit Icon
Upgrades
Not covered
Limit Icon
Contact lenses
In-Network: $0 copay
Limit Icon
Routine eye exam
In-Network: $0 copay
Limit Icon
Additional Coverage Icon

Wellness programs (eg, fitness, nursing hotline)

All service types
Not covered
Limit Icon
Overview Icon

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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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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