4

4 out of 5 stars* for plan year 2024

Plan ID: H3204-007

What You Need to Know:

  • Presbyterian Senior Care Plan 3 with Rx (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $120, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $3,000 per year (in-network).
  • Presbyterian Senior Care Plan 3 with Rx (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $51.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$120

Monthly Premium

Medicare Plan Features
Monthly Premium: $120.00
Part C Premium: $69.50
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$120.00 $69.50 $50.50 $0 $50.50 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H3204-008
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $3,000
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Torrance, New Mexico: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
35 members 3.5 out of 5 Stars. 4 out of 5 Stars. 3 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,198 drugs
Number of Members Enrolled in this Plan in Torrance, New Mexico: 3,105 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$69.50 $50.50 $0.00 $120.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$91.80 $43.50 $113.00 $36.40 $105.90 $29.40 $98.90
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
197 $0.00 1229 $10.00 527 $45.00 577 $95.00 668 33%

Other Medicare Advantage Plans in Torrance, New Mexico

Plan Name Type Premium MOOP Rx Deduct. Rating
Blue Cross Medicare Advantage Select (HMO) (2023)Local HMO$4,500$150
5
Blue Cross Medicare Advantage Basic (HMO) (2023)Local HMO$5,100$250
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Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
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HumanaChoice H5216-077 (PPO) (2023)Local PPO *$4,000$-
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HumanaChoice H5216-196 (PPO) (2023)Local PPO$5,500$0
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Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
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Humana Value Plus H5216-199 (PPO) (2023)Local PPO$7,550$435
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$3,800$150
5
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$4,300$-
5
Presbyterian Senior Care Plan 2 with Rx (HMO) (2023)Local HMO$4,500$0
4
Humana Honor (PPO) (2023)Local PPO *$4,400$-
4
Presbyterian Senior Care Plan 1 (HMO) (2023)Local HMO *$4,000$-
4
Amerivantage Care Access (HMO) (2023)Local HMO$7,550$445
5
Amerivantage Plus (HMO) (2023)Local HMO$6,700$0
5
Presbyterian MediCare PPO Plan 2 with Rx (PPO) (2023)Local PPO$6,700$335
4
Cigna True Choice Medicare (PPO) (2023)Local PPO$5,700$0
New plan - not yet rated.
Humana Gold Choice H8145-123 (PFFS) (2023)PFFS$-$300
4
Blue Cross Medicare Advantage Choice Plus (PPO) (2023)Local PPO$6,700$350
4
Molina Medicare Choice Care (HMO) (2023)Local HMO$7,550$445
5
Humana Gold Plus H0028-019 (HMO) (2023)Local HMO$4,000$0
4
UnitedHealthcare Medicare Advantage Assure (PPO) (2023)Local PPO$7,550$445
5
Presbyterian MediCare PPO Plan 1 (PPO) (2023)Local PPO *$6,700$-
4
Cigna Preferred Medicare (HMO) (2023)Local HMO$4,600$0
New plan - not yet rated.
Medicare Advantage Plans by Presbyterian Health Plan
Presbyterian Senior Care Plan 2 with Rx (HMO) (2023)Local HMO$4,500$0
4
Presbyterian Senior Care Plan 1 (HMO) (2023)Local HMO *$4,000$-
4

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