Presbyterian Senior Care (HMO) and Extra Health

Presbyterian offers you the value that comes with our integrated system of physicians, hospitals and health plan – all working together to keep you healthy. Most Presbyterian Medicare Advantage plans have $0 premiums and combine convenient ways to get care from home with low to no-cost options.

Eligibility and Enrollment

• You must be entitled to Medicare Part A and enrolled in Medicare Part B.

• You must live in one of these eight New Mexico counties:

  • Bernalillo

  • Cibola

  • Rio Arriba

  • Sandoval

  • Santa Fe

  • Socorro

  • Torrance

  • Valencia

With our HMO plans, you receive more benefits than Original Medicare (Part A and Part B) and several valuable services at no cost.

LIS/Extra Help

If you qualify for LIS (low-income subsidy) also known as Extra Help you will have reduced costs on your Part D prescription drugs. If you have a Late Enrollment Penalty (LEP) it will be removed.

Presbyterian Senior Care (HMO) Benefits

$0 copay for these valuable benefits and more!

• Primary Care Provider visits

• Routine dental cleanings, X-rays, and exams

• Routine eye exam

• Hearing exam (hearing aids also available with a copay)

• Telehealth visits

• Preferred generic drugs for Plan 2, Plan 3 and Extra Health

• Lab services and diagnostic tests

• Outpatient mental health visits

• Foot care

• Diabetic test strips and lancets

• Annual physical exam

• Annual Wellness Visit

Providing You with the Benefits You Need

$0 Telehealth Benefit

Access that works for you anytime, anywhere.

Need to see your network Primary Care Provider or Specialist but don’t want to go into the office? There’s no charge for any visit over video, telephone or online with your in-network providers. Check with your provider to see if they participate in telehealth appointments.

Telehealth options include:

• Primary Care Providers

• Specialists

• Urgent Care visits

• Outpatient Rehabilitation Services

• Behavioral Health Providers

$265 Vision Eyewear Allowance

Use your annual allowance to help pay for:

• Frames

• Lenses

• Contacts and contact lens fitting

• Prescription sunglasses

Over-the-Counter (OTC) 

Presbyterian Senior Care (HMO) plan 2 and plan 3 include an OTC allowance of $25 quarterly and Presbyterian Senior Care (HMO) Extra Health Plan includes an OTC allowance of $45 quarterly for approved health-related items. You can use your Presbyterian Healthy Benefits+ card online, in-store or catalog for purchases.

Special Supplemental Benefits for the Chronically Ill (SSBCI) - Grocery Benefit 

Presbyterian Senior Care (HMO) plans 2, 3 and Extra Health have a quarterly grocery allowance for qualifying members. Plan 2 and 3 have a $35 quarterly allowance and Extra Health has a $45 quarterly allowance. You must have a diagnosed chronic condition of diabetes, chronic hypertension, chronic hyperlipidemia and/or congestive heart failure CHF). You must also have completed an Annual Wellness Visit (AWV) in the last 12 months. Eligibility is determined by your plan and you may not be eligible even though you have one of these conditions.

Dental Plans to Meet Your Needs

Presbyterian Senior Care (HMO) plans include basic routine dental coverage through a contracted provider at no additional cost. A comprehensive dental buy-up option is also available for a monthly premium of $29.30.If you choose to add the Comprehensive Dental you would receive a $4000 annual maximum, and pay 20%-50% coinsurance for services through a Dentaquest provider.

More Plan Advantages

Enjoy Better Hearing and Comprehensive Care

Good hearing is important to your overall health. That’s why we cover a routine annual hearing exam at no cost to you. Presbyterian Senior Care plans cover up to two hearing aids per year (one per ear, per year) at discounted rates through our trusted hearing partner, TruHearing.

Improve Your Fitness with No Cost SilverSneakers® Memberships

The SilverSneakers Fitness program is included at no additional cost to you. Visit more than 15,000 participating nationwide locations, including Planet Fitness, Anytime Fitness, Defined Fitness, Chuze Fitness, YMCA, and more. You can also take classes online and enjoy on-demand video workouts from the comfort of your home.

Travel Worldwide and Be Protected with Assist America®

Enjoy the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year, for up to 90 days per emergency. This unique program immediately connects you to doctors, hospitals, pharmacies and other services when experiencing a medical emergency while traveling 100 miles or more away from your permanent residence or in another country. Some services are not covered by Presbyterian Senior Care (HMO) when traveling outside of the United States, such as inpatient stays, follow-up appointments, rehabilitation, etc. Other conditions and limitations apply.