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Presbyterian Senior Care (HMO)

 

Worry-Free Coverage. You're facing an exciting time in your life, and Presbyterian wants you to make the most of it. Healthcare information can be intimidating, but we make it easy, taking the guesswork out of choosing a plan by giving you precisely the information you need to make the best choice. Whether you are enjoying time with friends, playing with grandbabies, or trying something brand new, we've got you covered.

Enroll Now

Join Presbyterian Senior Care (HMO), a Medicare Advantage program.

2014 Enroll Now


Presbyterian Senior Care (HMO) Benefits Guide

The Benefits Guide provides a detailed overview of the benefits associated with this coverage plan.

2014 Benefits Guide

Call for a Quote

505-923-8458
1-800-347-4766
TTY: 1-888-625-6429
Monday through Sunday, 8:00 a.m.- 8:00 p.m.

Mail the completed Enrollment Form

2014 Enrollment Form
2014 Formulario de Solicitud de Inscripción Individual

Mail to:

Presbyterian Senior Care
P.O. Box 27489
Albuquerque, NM 87125-7489
Or fax a completed Enrollment Form to Presbyterian Senior Care at
505-923-5385

Medicare beneficiaries may also enroll in Presbyterian Senior Care through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.


Eligibility and Coverage

Presbyterian Senior Care (HMO) provides Medicare benefits to residents of the greater Albuquerque/Santa Fe area. To be eligible for Presbyterian Senior Care (HMO), you must live in the counties of

  • Bernalillo
  • Torrance
  • Sandoval
  • Valencia

or in ZIP codes

  • 87007, 87014, 87020, 87026 and 87038 (in Cibola)
  • 87010, 87015, 87056 and 87540 (in Santa Fe), or
  • 87062 or 87831 (in Socorro)

In addition, you must qualify for Medicare Parts A and B. You will have the option of selecting Part D (Drug) coverage. Enrollees cannot have permanent kidney failure requiring dialysis. There are exceptions, so contact us if you have questions.


Evidence of Coverage

The Presbyterian Senior Care (HMO) Evidence of Coverage guide provides information on the plan and coverage. You will be provided with a new Evidence of Coverage each year that you are enrolled.


Prescription Drug Coverage

Presbyterian Senior Care (HMO) Plans 2 and 3 include prescription drug coverage. The amount of coverage depends on the type of drug and the plan. Check the Formulary List to see if your drug is covered.

2014 Medicare Advantage Formulary List
2014 Formulario de medicamentos
What if my drug is not covered?

Formulary Updates

Supplement Formulary Information

Medication Therapy Management 2014

Medication Therapy Management is a program offered to Presbyterian Senior Care (HMO) and Presbyterian MediCare PPO Plan 2 or Plan 3 members. It is designed to help you get the most out of your medications by identifying and resolving any medication-related issues. This program is provided at no cost to our members.

Please click here to learn about the benefits and whether you are eligible

Please be sure a prescription drug benefit is part of your specific coverage before consulting this list. If you do not know if this program is offered to you, please contact:

Presbyterian Customer Service Center
505-923-6060
1-800-797-5343
TTY: 1-888-625-8818
Hours are Monday through Sunday from 8 a.m. to 8 p.m.

Coverage for some drugs may be limited to specific dosage forms and/or strengths. Your benefit design determines what is covered for you and what your copayment will be. Please refer to your benefit materials for your specific coverage information.

The medications listed on this Formulary/Preferred Drug List (PDL) are subject to change pursuant to the Formulary/PDL management activities of Presbyterian Health Plan and Presbyterian Insurance Company, Inc. (Presbyterian). This list is not all-inclusive nor does it imply a guarantee of coverage. In addition, coverage for some drugs listed may be limited to specific dosage forms and/or strengths. Substitution of a generic product for a brand-name drug is mandatory when a generic equivalent is available. If a member requests the brand-name drug in this situation, a pharmacy exception may be required and the member must pay the difference in cost between the generic and branded versions. Non-formulary medications are not considered for coverage unless trial and failure of Formulary alternatives are documented.

For more information on prescription drug benefits, see Understanding Formularies , Formulary Terms , and Utilization Management Information.


Presbyterian Plan Rating

All Medicare health and prescription drug programs are rated each year based on the plan's quality and performance. Plan rating information can be used to compare one plan with another. Plan performance Star Ratings are assessed each year and may change from one year to the next.

2014 Presbyterian Senior Care (HMO) Rating
Calificaciones del Plan de Medicare para el Año Calendario 2014


Presbyterian Providers and Pharmacies

The providers and pharmacies available to you through this plan are detailed in the Provider Directory.

2014 Provider Directory
2014 Directorio de proveedores
Find a Provider


Summary of Benefits

The Presbyterian Senior Care (HMO) Summary of Benefits tells you some features of our Plan. It doesn't list every service that we cover or list every limitation or exclusion.

2014 Presbyterian Senior Care Summary of Benefits
Resumen de Beneficios de Presbyterian Senior Care 2014


Annual Notice of Change

Learn more about the Presbyterian Senior Care (HMO) Annual Notice of Change benefits that were effective January 1, 2014 and other important information about your coverage.

Watch Presbyterian Senior Care (HMO) ANOC 2014 on Vimeo.com


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