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Current Presbyterian Medicare Advantage Members

Take an in-depth look at what Presbyterian Medicare Advantage plans have to offer for 2021.

Summary of Benefits

Quickly look up your 2021 Presbyterian Medicare Advantage benefits or compare plans. Not sure what plan you have? Check your Presbyterian Member ID card.

Dental Coverage Worth Smiling About

Your Presbyterian Medicare Advantage Plan now includes dental coverage options, each with a robust network of more than 2,200 in-network dental providers throughout New Mexico.


 

Basic Services - Included

Basic dental coverage is included in your Medicare Advantage medical plan and covers all preventive dental services at 100% for in-network services.

  • Oral exams (two every 12 months)
  • Cleanings (two every 12 months)
  • Dental x-rays (frequency varies by type)
  • Fluoride treatments (two every 12 months)
  • Periodontal maintenance (four every 12 months)
  • Emergency treatment of minor pain

New  Comprehensive Plan - Optional

Comprehensive dental coverage is available to Senior Care HMO Plan 1-3 and MediCare PPO Plan 1-2 members for an additional monthly premium of $19 per member. Services must be obtained through an in-network provider.

  • Members pay 20% for fillings, extractions, and denture adjustments/repairs
  • Members pay 50% coverage for major restoratives (for example, crowns, bridges, root canals, dentures, periodontics, implants, anesthesia)
  • Maximum $3,000 calendar year benefit (amount is based on what your plan pays for dental services)
  • No deductible or waiting period

Want to Enroll in Comprehensive Dental?

The Comprehensive Dental plan coverage is available beginning January 1, 2021. Members can enroll year-round in this Comprehensive Dental plan for $19 per month. To enroll, print a copy of the Comprehensive Dental Plan Form by clicking on the "Comprehensive Dental Enrollment Form” link below and return by fax or mail. Your coverage will begin the 1st day of the month following receipt of the form.


Member Resources

Whether you’re a new member or have been with us a while, you’re bound to have questions or need assistance. Here are the most helpful tools—all in one spot.

Your Member ID Card

After enrollment, you are given a Presbyterian Medicare Advantage plan identification card. You must use your membership card for our plan whenever you get any services covered by this plan. Here’s why this is so important: If you get covered services using your red, white, and blue Medicare card instead of using your Presbyterian Medicare Advantage membership card while you are a plan member, you may have to pay the full cost yourself.

If your Presbyterian Medicare Advantage plan membership card is damaged, lost, or stolen, log in to your myPRES account and select MyIDCard to print, fax, or email your ID Card.

If you would like a replacement card, please contact the Presbyterian Customer Service Center.

505-923-6060 or 1-800-797-5343 (TTY 711)
Hours: 8 a.m. to 8 p.m., Monday - Friday


Remember: As long as you are a member of our plan you must not use your red, white, and blue Medicare card to get covered medical services (with the exception of routine clinical research studies and hospice services). Keep your red, white, and blue Medicare card in a safe place in case you need it later.

Presbyterian Members Approaching Age 65

If you're a Presbyterian member and are starting to think about Medicare, we'll help you plan ahead so your Presbyterian Health Plan coverage continues without interruption.

Medicare Basics explains the basics of how Medicare works. Keep these 3 steps in mind to stay on track for enrollment:

6 Months Before You Turn 65

Confirm your Medicare eligibility with Social Security and request your Medicare card.

3 Months Before You Turn 65

Explore your Medicare plan options using the Rates and Benefits section of this site, and then start the enrollment process.

65th Birthday

Complete your enrollment. You can enroll up to three months after the month of your 65th birthday. For example, if you turn 65 on March 5, you have until the end of June to enroll.

To learn more about your Medicare plan options, attend a seminar or
contact us.

 

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Last Updated: 06/08/2021