Presbyterian Senior Care Plan 1 is a 2022 Medicare Advantage HMO plan, from Presbyterian Healthcare Services, that's available to Medicare beneficiaries living in Bernalillo County, New Mexico.
- It's a Health Maintenance Organization (HMO) health plan.
- It provides all the same benefits as Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage..
- It may offer extra benefits that Original Medicare does not cover.
- There's a $5 copayment to see your primary care physician (Doctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get...).
- The monthly premium is $0.00 (plus your monthly The Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above...).
- The health plan does not have an annual A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share..
- The maximum Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. with this plan is $4,000 (in-network).
If you join this HMO plan, it will replace your Original Medicare coverage in Bernalillo County and you must agree to let Presbyterian Healthcare Services manage your Medicare benefits, including:
IMPORTANT: With Presbyterian Senior Care Plan 1 you are required to use healthcare providers in the plan's network. If you don't you will incur all costs. Plus, referrals from your primary care physician may be required to see a specialist.
NOTE: Presbyterian Senior Care Plan 1 does not include prescription drug coverage (no drug plan). To get it, you can add one of the stand-alone Medicare Drug Plans in New Mexico.
The monthly premium if you join Presbyterian Senior Care Plan 1 is $0.00 per month. Plus, you must continue to pay your monthly Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. premium. Some plans offers a Medicare Part B premium reduction, sometimes called a premium give back. This plan's Part B premium reduction is NONE.
Co-payments and/or co-insurances also apply with most healthcare services, except preventative care mandated by CMS (see H3204-008 Summary of Benefits below).
IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.
Maximum Out-of-Pocket (MOOP) Limit
Unlike Original Medicare, Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The Presbyterian Senior Care Plan 1 plan MOOP is $4,000 . Once you reach this amount of spending on your A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., all of your Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B services will be covered at no additional charge for the remainder of the year.
NOTE: MOOP does not include what you spend on monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. . It also does not apply to your prescription drugs, Part D deductible, or any other extra benefits bundled in the plan.
CRITICAL: Be sure to evaluate the annual premiums and MOOP of Presbyterian Senior Care Plan 1 versus what you might expect to pay for a Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. in Bernalillo County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage plans with a similar annual cost.
Contact Presbyterian Healthcare Services
If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov. To learn more about this plan, visit the Presbyterian Healthcare Services Medicare website.
Additional Medicare Plan Options in Bernalillo County
Are you eligible for a Bernalillo County, NM Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:
- Wellcare Dual Liberty (Local HMO), for Dual-Eligible beneficiaries
- Blue Cross Medicare Advantage Dual Care Plus (Local HMO), for Dual-Eligible beneficiaries
- Amerivantage ESRD Care (Local HMO), for Chronic or Disabling Condition beneficiaries
- Wellcare Dual Access (Local HMO), for Dual-Eligible beneficiaries
- Presbyterian Dual Plus (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- Wellcare No Premium (HMO)
- AARP Medicare Advantage Patriot (PPO)
- Wellcare Giveback (HMO)
- Imperial Insurance Traditional Plus (HMO)
- Humana Gold Plus H0028-019 (HMO)