Presbyterian Senior Care Plan 1 (HMO) H3204-008-0 Plan Details
Presbyterian Senior Care Plan 1 (HMO) H3204-008-0 Plan Details
When selecting a Medicare Advantage plan for 2025, it's important to compare all your options. Presbyterian Senior Care Plan 1 (HMO) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
Presbyterian Senior Care Plan 1 Overview
Plan ID H3204-008-0 Overview | |
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Health Plan ID: | H3204-008-0 |
Medicare Advantage Plan Type: | Local HMO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $4,250 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Not Included |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Presbyterian Health Plan |
Explore Presbyterian Senior Care Plan 1 Benefits
Presbyterian Senior Care Plan 1 is a Medicare Advantage Health Maintenance Organization (HMO) plan that delivers comprehensive healthcare coverage at an affordable price. With a monthly premium of $0.00, this plan covers all the essential benefits of Medicare Part A and Part B. As an HMO plan, Presbyterian Senior Care Plan 1 typically requires you to select a primary care physician and receive care within the plan’s network, ensuring coordinated and cost-effective care.
Please note that Presbyterian Senior Care Plan 1 does not include a Part D plan. If you require prescription drug coverage, consider exploring standalone Medicare drug plans. Presbyterian Senior Care Plan 1 also offers financial security with an annual maximum out-of-pocket (MOOP) limit of $4,250. After reaching this limit, your in-network healthcare costs are fully covered for the rest of the year. This feature makes Presbyterian Senior Care Plan 1 a reliable option for those who prefer a structured approach to managing their healthcare.
We're Here to Help You Enroll |
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Out-of-Pocket Costs
Presbyterian Senior Care Plan 1 includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H3204-008-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 |
Specialist: | $55 Copay |
Wellness & Preventive Programs: | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $0 Copay |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $20 Copay |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $120 Copay |
Urgent care: | $60 Copay |
Ground ambulance: | $275 Copay |
Inpatient hospital care: | $350.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital care: | $350 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $175.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $0 |
Outpatient group therapy: | $0 |
Inpatient psychiatric hospital care: | $350.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy: | $0 |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $25 Copay |
Occupational therapy: | $25 Copay |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $325 Copay |
Lab services: | $0 |
Outpatient x-rays: | $25 Copay |
Diagnostic tests and procedures: | $0 |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Presbyterian Senior Care Plan 1 as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Presbyterian Health Plan offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Covered Limits may apply |
Vision | Maximum vision benefit: | $250.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
CMS Measure | Star Rating |
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2024 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):
Who Can Enroll in Presbyterian Senior Care Plan 1?
To qualify for enrollment in Presbyterian Senior Care Plan 1, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
- Not have End-Stage Renal Disease (ESRD), except under certain conditions.
If you fulfill these criteria, you can enroll in Presbyterian Senior Care Plan 1 and enjoy the extensive healthcare benefits it offers.
When Can I Enroll in Presbyterian Senior Care Plan 1?
Understanding the right time to enroll in Presbyterian Senior Care Plan 1 is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
Steps to Enroll in Presbyterian Senior Care Plan 1
Enrolling in Presbyterian Senior Care Plan 1 is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Presbyterian Senior Care Plan 1 through the official Medicare website.
- Directly with Presbyterian Senior Care Plan 1: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Contact Presbyterian Health Plan
Website: | http://www.phs.org/Medicare |
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Formulary: | http://www.phs.org/Medicare |
Pharmacy: | Presbyterian Health Plan Pharmacy Page |
New Members: | (800)347-4766 |
TTY Users: | (800)659-8331 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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