Plan H3204-008-0: Presbyterian Senior Care Plan 1 (HMO) – 2025 Coverage Details
This page provides coverage, cost, and availability details for Presbyterian Health Plan’s H3204-008-0 Medicare Advantage plan for 2025.
*CMS rated this Presbyterian Health Plan plan (H3204-008-0) 3 (Average) out of 5 stars.
Presbyterian Senior Care Plan 1 Basic Plan Details
- Plan ID
- H3204-008-0
- Plan Type
- HMO
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 4,250.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Not Included
- Supplemental Benefits
- Vision, Hearing
- Availability
- See List
- Insured By
- Presbyterian Health Plan
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
This Presbyterian Health Plan Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H3204-008-0.
NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
Doctor's Office Visits
- Primary
- Not Covered
- Specialist
- $55 Copay
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $125 Copay
- Urgent care
- $55 Copay
- Ground ambulance
- $350 Copay
- Inpatient hospital care
- $350.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond - Skilled Nursing Facility
- $0.00 per day for days 1 through 20
$185.00 per day for days 21 and beyond
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- Not Covered
- Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- $20 Copay
- Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- Not Covered
- Outpatient group therapy
- Not Covered
- Inpatient psychiatric hospital care
- $350.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond
Rehabilitation Services
- Physical therapy and speech and language therapy
- $25 Copay
- Occupational therapy
- $25 Copay
Medical Equipment and Supplies
- Diabetes supplies
- Not Covered
- Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $325 Copay
- Lab services
- Not Covered
- Outpatient x-rays
- $25 Copay
- Diagnostic tests and procedures
- Not Covered
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- $55 Copay
- Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Not Covered
- Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- $ to $15 Copay
- Routine eye exam
- Covered
Limits may apply - Eyewear benefits
- None
Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) and drug plans (Part D) in several major categories using a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join Presbyterian Senior Care Plan 1 .
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Plan Availability
Presbyterian Senior Care Plan 1 (H3204-008-0) is available in the following locations (click to open):
Additional Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
- H3204-007-0: Presbyterian Senior Care Plan 3 with Rx (HMO)
- H3204-016-0: Presbyterian Senior Care AssistPlus Plan with Rx (HMO)
- H3204-001-0: Presbyterian Senior Care Plan 2 with Rx (HMO)
- H3204-008-0: Presbyterian Senior Care Plan 1 (HMO)
- H3204-015-0: Presbyterian UltraFlex (HMO-POS)
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact Us About Presbyterian Health Plan
| Website: | Presbyterian Health Plan Plan Page (opens in new tab) |
|---|---|
| Providers: | Presbyterian Health Plan Providers Page (opens in new tab) |
| New Member Health Plan Help: | (800)347-4766 |
| New Member Health Plan TTY: | (800)659-8331 |
If you qualify for Medicare benefits 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 Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- Presbyterian Health Plan, http://www.phs.org/Medicare, Last Accessed March 1, 2025
- Medicare.gov, "Your health plan options", Last Accessed February 20, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Is Your Test, Item, or Service Covered?", Last Accessed March 19, 2025
- CMS.gov, Landscape Source Files, Last Accessed March 15, 2025
- CMS.gov, Medicare Part C & D Performance, Last Accessed March 15, 2025
- CMS.gov, Plan Benefits Package,Last Accessed March 15, 2025
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
Plans Offered
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