Plan Details
Costs and Other Important Information
Benefits
$0 for days 6 through 90
$5 per visit
Specialist:
$40 per visit
$80 per visit (always covered)
Urgent care:
$5-65 per visit (always covered)
$0 copay
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
$250
Outpatient x-rays:
$0 copay
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
$0 copay
Outpatient individual therapy visit with a psychiatrist:
$0 copay
Outpatient group therapy visit:
$0 copay
Outpatient individual therapy visit:
$0 copay
$75 for days 21 through 100
$20
Physical therapy and speech and language therapy visit:
$20
$0 copay
Routine foot care:
Not covered
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
$0-10 per item
0-5%
Other Part B drugs:
$10 or 0-5%
Coverage Area for Presbyterian Senior Care 3 with Rx (HMO)
State | New Mexico |
---|---|
County | Bernalillo |
Cost Sharing Information
All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit
30 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
---|---|---|---|
Tier 1: Preferred Generic | Not offereds | $4 copay | $4 copay |
Tier 2: Non-Preferred Generic | Not offered | $10 copay | $10 copay |
Tier 3: Preferred Brand Name | Not offered | $45 copay | $45 copay |
Tier 4: Non-Preferred Brand Name | Not offered | $95 copay | $95 copay |
Tier 5: Specialty Tier | Not offered | 28% coinsurance | 28% coinsurance |
90 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
---|---|---|---|
Tier 1: Preferred Generic | Not offered | $12 copay | $8 copay |
Tier 2: Non-Preferred Generic | Not offered | $30 copay | $20 copay |
Tier 3: Preferred Brand Name | Not offered | $135 copay | $112.5 copay |
Tier 4: Non-Preferred Brand Name | Not offered | $285 copay | $285 copay |
Tier 5: Specialty Tier |
CMS Ratings
Staying healthy - screenings, tests and vaccines
Managing Chronic Conditions
Member Experience with Health Plan
Member Complaints, and Changes in Health Plan's Performance
Health Plan Customer Service
Drug Plan Customer Service
Member Complaints, and Changes in Drug Plan's Performance
Member Experience with Drug Plan
Drug Pricing and Patient Safety
Physician Finder
Physicians that accept Presbyterian Senior Care 3 with Rx (HMO) for New Mexico
Similar Plans
Premium | Plan Name | CMS Rating | |
---|---|---|---|
from $12 | ![]() Aetna Medicare Rx Select (PDP) | Details | |
from $28 | ![]() SilverScript Choice (PDP) | Details | |
from $0 | ![]() Humana Gold Plus H2649-029 (HMO) | Details | |
from $0 | Blue Cross Blue Shield of IL, MT, NM Blue Cross Medicare Advantage Basic (HMO) | Details | |
from $22 | ![]() Express Scripts Medicare - Saver (PDP) | Details |