2018 Presbyterian MediCare PPO Plan 1 (PPO) H3206-3-0 in NM from Presbyterian | HealthPocket

Presbyterian MediCare PPO Plan 1 (PPO)


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Zip Code87121
Applicant10/18/1983 Male
Coverage Start10/21/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C)
Insurance ProviderPresbyterian
Plan IDH3206-3-0
Plan Year2018
CMS Rating
Plan TypePPO
Annual Deductible$0.00

What To Know About This Plan
  • This is a health coverage only plan with no drug coverage
  • This plan is available for 2019. see plan

Why We Like This Plan
  • gives you freedom to choose which doctors, specialist and hospitals you visit

Costs and Other Important Information

Plan Year2018
Prescription Drugs Covered?Yes
Health Plan Deductible$0
Monthly Drug Plan Premium$0
Monthly Health Plan Premium$95

Coverage Area for Presbyterian MediCare PPO 1 (PPO)

StateNew Mexico

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 managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
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/TDD availability - Drugs
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 planNot Rated
Beneficiary access and performance problems
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
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physicians that accept Presbyterian MediCare PPO 1 (PPO) for New Mexico

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Dozeman, Lynn
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Tam, Adela
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Candelaria, Delfino
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Buxton, Benjamin
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Loughrey, Galen
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Peachey, Marilyn
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Fetner, Jean
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Guerrero-pezzano, Tatyana
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Montoya, Andrea
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Miller, Frederick
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Shelley, Brian
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Kassicieh, Samir
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Hockin, Benjamin
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Gallegos-macias, Angela
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Ponce, Liana
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Jacobsohn, Vanessa Cook
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Jansen, Shari
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Gurule, Monica
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Barnes, Jesse
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Buckels, Wendy
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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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