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Y0055_MPC082475_Approved_M_09172024
Last Updated: 10/1/2024

Presbyterian Dual Plus (HMO D-SNP)

Dual Eligible Special Needs Plan (SNP) for people who have both Medicare and Medicaid. How much Medicaid covers depends on your income, resources and other factors. Some people get full Medicaid benefits, while others get help paying for certain Medicare costs. Those costs may include premiums, deductibles, coinsurance, and copays.

Dual Plus Benefits

2025 Presbyterian Dual Plus (HMO D-SNP) Summary of Benefits

Eligibility

To enroll in Presbyterian Dual Plus (HMO D-SNP) H3204-013-004, H3204-013-005 or H3204-013-006:

  • You must be entitled to Medicare Part A and enrolled in Medicare Part B. Enrollment in a specific DSNP plan is based on the county you live in. Learn more about Medicare

  • You must live in one of these New Mexico counties: Bernalillo, Catron, Cibola, Chaves, Colfax, Curry, De Baca, Doña Ana, Eddy, Grant, Guadalupe, Harding, Hidalgo, Lea, Lincoln, Los Alamos, Luna, McKinley, Mora, Otero, Quay, Rio Arriba, Roosevelt, Sandoval, San Miguel, San Juan, Santa Fe, Sierra, Socorro, Taos, Torrance, Union, or Valencia. The plan you will be enrolled in will depend on the county you live in.

  • You must be in one of the Medicaid categories below.

    • Qualified Medicare Beneficiary Plus (QMB+): You get Medicaid coverage of Medicare cost-share and are also eligible for full Medicaid benefits. Medicaid pays your Part A and Part B premiums, deductibles, coinsurance and copayment amounts. You pay nothing, except for Part D prescription drug copays.

    • Qualified Medicare Beneficiary (QMB): You get Medicaid coverage of Medicare cost-share but are not eligible for full Medicaid benefits. Medicaid pays your Part A and Part B premiums, deductibles, coinsurance and copayments amounts only. You pay nothing, except for Part D prescription drug copays.

    • Qualified Disabled and Working Individual (QDWI): Medicaid pays your Part A premium only. The State Medicaid Office does not pay your cost-share. You do not have full Medicaid benefits. There may be some services that do not have a member cost share amount.

    • Specified Low-Income Medicare Beneficiary (SLMB+): Medicaid pays your Part B premium and provides full Medicaid benefits. You are eligible for full Medicaid benefits. At times you may also be eligible for limited assistance from your state Medicaid agency in paying your Medicare cost-share amounts. [Generally, your cost share is 0% when the service is covered by both Medicare and Medicaid. There may be cases where you must pay cost sharing when a service or benefit is not covered by Medicaid.]

    • Full Benefits Dual Eligible (FBDE): Medicaid may provide limited assistance with Medicare cost-sharing. Medicaid also provides full Medicaid benefits. You are eligible for full Medicaid benefits. At times you may also be eligible for limited assistance from the State Medicaid Office in paying your Medicare cost-share amounts. If you are eligible for Medicare cost-sharing assistance under Medicaid, you are not responsible for paying any out-of-pocket costs for Part A and Part B services.