Presbyterian MediCare PPO Members
Learn more about your plan benefits, managing your plan and how to access care.
Your Plan Documents
Find important plan information related to your 2024 Presbyterian MediCare PPO plan.
Summary of Benefits
Evidence of Coverage
Annual Notice of Change (ANOC)
Didn't find what you are looking for?
Manage Your Care
You have many options for getting care through your health plan. Visit the Get Care webpage for help finding the best care option for your situation.
Need to find a provider?
Check out the Provider Directory for a list of in-network providers and pharmacies.
Dental Coverage & Providers
Your plan includes basic dental coverage through a contracted provider* at no additional cost to you. Services include:
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)
*MediCare PPO members may use non-contracted providers but may pay higher out-of-pocket costs.
Start using your preventive dental benefits today!
Manage Your Plan
Interested in changing your plan?
Open Enrollment Period is from October 15 - December 7. You can switch your Presbyterian Medicare Advantage plan. The coverage start date is January 1 of the next year.
Medicare Advantage Open Enrollment Period is from January 1 – March 31. You can switch your Presbyterian Medicare Advantage plan. The coverage start date is the first of the month after we get your request.
Special Enrollment Period is available year-round but is only for certain situations that happen in your life, like moving to a new address, getting Medicaid, or getting Extra Help. The coverage start date varies but generally is the first of the month after we get your request.
To get started, please have your 11-digit member ID number and date of birth.Online Plan Change Form
Add Additional Dental Coverage
A Comprehensive Dental Plan is available for an additional monthly premium. You may enroll online anytime. Already enrolled? You don’t need to do anything.
Enroll to receive these extra benefits.
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)
No Prior Authorization needed for covered services
Services not covered include implants, cosmetic procedures, bone grafts and tissue regeneration