2020 Presbyterian Senior Care Plan 1 (HMO) H3204-8-0 in NM from Presbyterian | HealthPocket

Presbyterian Senior Care Plan 1 (HMO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C)
Insurance ProviderPresbyterian
Plan IDH3204-8-0
Plan Year2020
CMS Rating
Plan TypeHMO
Annual Deductible$0.00
Out-of-Pocket Maximum4000

What To Know About This Plan
  • This is a health coverage only plan with no drug coverage

Why We Like This Plan
  • has no additional premium costs outside of your Medicare Part B premium

Overview

Premium
Total monthly premium$0.00
Health plan premium$0.00
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$0
Estimated yearly costs
Estimated total yearly costs for care$7,098.00
Out-of-pocket max
Out-of-pocket max$4,000 In-network

Benefits & costs

Doctor services
Primary doctor visit$5 per visit
Specialist visit$50 per visit
Tests, labs, & imaging
Diagnostic tests & procedures$0 copay
Lab services$0 copay
Diagnostic radiology services (like MRI)$300
Outpatient x-rays$20
Emergency care$90 per visit (always covered)
Urgent care$15-65 per visit (always covered)
Hospital services
Inpatient hospital coverage$325 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage$325 per visit
Skilled nursing facility
Skilled nursing facility$0 per day for days 1 through 20
$95 per day for days 21 through 65
$0 per day for days 66 through 100
Preventive services
Preventive services$0 copay
Ambulance
Ground ambulance$250
Therapy services
Occupational therapy visit$20
Physical therapy & speech & language therapy visit$20
Mental health services
Outpatient group therapy with a psychiatrist$0 copay
Outpatient individual therapy with a psychiatrist$0 copay
Outpatient group therapy visit$0 copay
Outpatient individual therapy visit$0 copay
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)20% per item
Prosthetics (like braces, artificial limbs)20% per item
Diabetes supplies$0 copay

Extra benefits & costs

Hearing
Hearing exam$0 copay
Fitting/evaluationNot covered
Hearing aids - All types$699-999
Preventive dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-raysNot covered
Comprehensive dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye exam$0 copay
Contact lensesNot covered
Eyeglasses (frames & lenses)Not covered
Eyeglass frames (only)Not covered
Eyeglass lenses (only)Not covered
UpgradesNot covered
More benefits
Fitness benefitLimited coverage
Over the counter drug benefitsNot covered
In-home support servicesNot covered
Routine chiropractic serviceLimited coverage
Home and bathroom safety devicesNot covered
Meals for short durationNot covered
Annual physical examsLimited coverage
TelehealthLimited coverage

Drug coverage & costs

Part B drugs
Chemotherapy drugs20%
Other Part B drugs$10 or 20%

Coverage Area for Presbyterian Senior Care 1 (HMO)

StateNew Mexico
CountyBernalillo

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain assessment
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Rheumatoid arthritis management
Reducing the risk of falling
Improving bladder control
Medication reconciliation post-discharge
Plan all-cause readmissions
Statin Therapy for Patients with Cardiovascular Disease

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Rating of health care quality
Rating of health plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY availability
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
Medication adherence for diabetes medications
Medication adherence for hypertension - RAS antagonists
Medication adherence for cholesterol - Statins
MTM program completion rate for CMR
Statin use in persons with diabetes - SUPD

Physicians that accept Presbyterian Senior Care 1 (HMO) for New Mexico

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Lynn, Dozeman
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Tatyana, Guerrero-pezzano
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Galen, Loughrey
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Adela, Tam
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Marilyn, Peachey
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Jean, Fetner
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Benjamin, Buxton
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Delfino, Candelaria
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Angela, Gallegos-macias
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Keith, Vargas
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Shari, Jansen
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Liana, Ponce
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Monica, Gurule
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Frederick, Miller
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Andrea, Montoya
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Jesse, Barnes
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Vanessa Cook, Jacobsohn
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Wendy, Buckels
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Samir, Kassicieh
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Christopher, French
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Benjamin, Hockin
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Brian, Shelley
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Lynn Dozeman, MD
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  • Phone Number
    (505) 831-2534
  • Office Locations
    6900 Gonzales Rd Sw
    Albuquerque, NM 87121
6900 Gonzales Rd Sw Albuquerque NM, 87121
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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).