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Current Presbyterian Medicare Advantage Members

Take an in-depth look at what our Presbyterian Medicare Advantage plan has to offer for 2022.

Annual Notice of Change (ANOC)

Summary of Benefits

Quickly look up your 2022 Presbyterian Medicare Advantage benefits or compare plans. Not sure what plan you have? Check your Presbyterian Member ID card.

Dental Plans to Meet Your Needs

Your Presbyterian Senior Care (HMO) and Presbyterian MediCare PPO plans includes basic dental coverage through a contracted provider. An additional comprehensive option is available for a low monthly cost.

Visit Dentaquest to search for providers.


 

 

Basic Dental Plan – Included in your plan for no additional cost!

No enrollment necessary.

Pay $0 for all preventive dental services with contracted providers*:

  • Oral exams, cleanings, and fluoride treatments (two every 12 months)
  • Dental x-rays (frequency varies by type)
  • Periodontal maintenance (four every 12 months)
  • Emergency treatment of minor pain (as needed)

Optional Comprehensive Dental Plan

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 $9 per member for Senior Care and $19 for MediCare PPO. Enroll to receive these extra benefits*. Already enrolled? You don’t need to do anything.

  • Includes all the coverage of the basic dental plan
  • Use services right away. No deductible or waiting period required!
  • $4,000 calendar-year benefit maximum (Unused portion does not carry forward to next year's benefit)
  • Prior Authorization rules have been removed to eliminate barriers for approval of services
  • Services not covered include implants, cosmetic procedures, bone grafts and tissue regeneration

How to enroll in the Comprehensive Dental Plan

Beginning October 15 Senior Care HMO Plan 1-3 and MediCare PPO Plan 1-2 members can enroll online in the Comprehensive Dental plan.

* Senior Care HMO members must obtain services through a contracted DentaQuest provider. MediCare PPO members may use non-contracted providers but will pay higher out of pocket costs.

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., Sunday - Saturday


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: 10/03/2021