Presbyterian UltraFlex (HMO-POS)

Presbyterian Medicare Advantage plans combine safe ways to get care from home with many $0 and low-cost options, and $0 premium options, so you can get the care you need. Presbyterian offers you the value that comes with our integrated system of physicians, hospitals and health plan – all working together to keep you healthy.

With our HMO-POS plans, you receive more benefits than Original Medicare (Part A and Part B) and several valuable services for $0 copay.

Our $0 premium Presbyterian UltraFlex (HMO-POS) plan goes perfectly with all your retirement plans. Your benefits include:

• An $860 flex card to help pay for over-the-counter drugs and more

• No-cost primary care visits

• More telehealth providers with $0 telehealth visits with PCPs, specialists, and urgent care

• Out-of-network benefit with a flat copay

• Dental, vision and hearing aid coverage

• Drug coverage with no deductible

• Routine acupuncture and chiropractic care

• Worldwide coverage for emergencies

• And more! See your 2024 Presbyterian UltraFlex (HMO-POS) Plan Summary of Benefits

Providing You with the Benefits You Need

Flex Card Exclusively for UltraFlex Members

Presbyterian UltraFlex (HMO-POS) members receive a Flex card loaded with $215 per quarter to use for these out-of-pocket expenses:

• Hearing – Hearing aids and batteries or other hearing services.

• Dental – Many dental services not covered by your plan including out-of-network dental providers.

• Vision – Frames, lenses and contacts, including fittings with any Medicare-approved vision provider that accepts VISA®.

• Over-the-Counter (OTC) health items – Non-prescription medications and other health-related items may be purchased through mail order or at participating retail stores, including Dollar General, Walgreens, Walmart, Smith's and CVS.

Any unused balance carries over to the next quarter within the calendar year but does not carry over into the next year. A total of $215 can be used each quarter in any combination for eligible expenses, or the full $860 can be saved and used all at once at the end of the year. Members can check their account balance and find participating retail stores online by logging into myPRES or by calling a customer support phone number.

$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 network providers.

Telehealth options include visits with:

• Your Primary Care Provider

• Specialists

• Urgent Care

• Outpatient Rehabilitation Services

• Behavioral Health Providers

Dental Plans to Meet Your Needs

Presbyterian UltraFlex (HMO-POS) includes basic dental coverage through a contracted provider. An additional comprehensive option is available for a monthly cost.

Enjoy Better Hearing and Comprehensive Care

Good hearing is important to your overall health. That’s why we cover a routine annual hearing exam for no copay. UltraFlex covers up to two hearing aids per year (one per ear per year).

Improve Your Fitness with Free 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.

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.

Meals

Up to 30 meals delivered to your home during the four-week period following an inpatient hospital stay. This benefit is offered through Meals on Wheels.

Presbyterian UltraFlex (HMO-POS) Eligibility and Enrollment

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

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

  • Bernalillo

  • Cibola

  • Curry

  • Dona Ana County

  • Lincoln

  • Rio Arriba

  • Sandoval

  • Santa Fe

  • Socorro

  • Torrance

  • Valencia

  • Quay