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Presbyterian MediCare PPO


Coverage You Can Be Confident In. Presbyterian wants you to make the most of this time in your life. We make understanding healthcare coverage easy, taking the mystery out of choosing a plan so you can feel confident in your choice. Enjoy learning something new and spending time with friends, knowing that we've got you covered.

Enroll Now

Join Presbyterian MediCare PPO, a Medicare Advantage program.

2014 Enroll Now

Presbyterian MediCare PPO Benefits Guide

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

2014 Benefits Guide

Call for a Quote

Monday through Sunday, 8:00 a.m. - 8:00 p.m.
TTY: 1-888-625-6429

Mail the completed Enrollment Form

2014 Enrollment Form
2014 Formulario de Solicitud de Inscripción Individual

Mail to:

Presbyterian MediCare PPO
P.O. Box 25361
Albuquerque, NM 87125-9762
Or fax a completed Enrollment Form to Presbyterian MediCare PPO at

Medicare beneficiaries may also enroll in Presbyterian MediCare PPO through the CMS Medicare Online Enrollment Center.

Eligibility and Coverage

Presbyterian MediCare PPO provides Medicare benefits to residents of New Mexico.

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

Evidence of Coverage

The Presbyterian MediCare PPO 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.

2014 Presbyterian Medicare PPO Evidence of Coverage Plan 1
2014 Constancia de cobertura de Presbyterian MediCare PPO Plan 1
2014 Presbyterian MediCare PPO Evidence of Coverage Plans 2 & 3
2014 Constancia de cobertura de Presbyterian MediCare PPO Plans 2 & 3

Prescription Formulary List

Presbyterian MediCare PPO 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 which list is correct, please contact the Presbyterian Customer Service Center at 505-923-6060 or 1-800-797-5343 for assistance. TTY users may call 1-888-625-8818.

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.

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 MediCare PPO Plan Rating
Calificaciones del plan para el año calendario correspondiente a 2014 de Medicare

Presbyterian Providers and Pharmacies

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

Provider Directory
2014 Directorio de proveedores
Find a Provider

Summary of Benefits

The Presbyterian MediCare PPO 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 MediCare PPO Summary of Benefits
Resumen de beneficios de 2014

Annual Notice of Change

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

Watch Presbyterian MediCare (PPO) ANOC 2014 on