Presbyterian Senior Care Plan 3 with Rx (HMO) in Rio Arriba, New Mexico (2023)
Presbyterian Senior Care Plan 3 with Rx (HMO) in Rio Arriba County, New Mexico costs $120/mo. This affordable Regional PPO plan (H3204-007) is a top choice for those living in Rio Arriba County with a $0 prescription deductible and out-of-pocket limits at $3,000. Learn more about Medicare Part C by AARP in Rio Arriba County, New Mexico below.
Read moreUPDATED: Sep 21, 2023
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UPDATED: Sep 21, 2023Fact Checked
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4 out of 5 stars* for plan year 2024
Plan ID: H3204-007
What You Need to Know:
- Presbyterian Senior Care Plan 3 with Rx (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
- It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
- It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
- The plan's monthly premium is $120, which does not include your monthly Medicare Part B premium.
- The annual deductible for this health plan is .
- The plan includes an out-of-pocket maximum of $3,000 per year (in-network).
- Presbyterian Senior Care Plan 3 with Rx (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
- This plan's Part D Initial Coverage Limit is $51.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$120
Monthly Premium
| Medicare Plan Features | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Monthly Premium: | $120.00 | ||||||||
| Part C Premium: | $69.50 | ||||||||
| Monthly Premium: | Part C Premium: | Part D Drug Premium: | Part D Supplemental Premium: | Total Part D Premium: | Drug Deductible: | Tiers with No Deductible: | |||
| $120.00 | $69.50 | $50.50 | $0 | $50.50 | $0 | 0.0 | |||
| Gap Coverage: | Yes | ||||||||
| Benchmark: | not below the regional benchmark | ||||||||
| Type of Medicare Health: | Enhanced Alternative | ||||||||
| Health Plan Type: | Local HMO | ||||||||
| Similar Plan: | H3204-008 | ||||||||
| Special Needs Type: | NULL | ||||||||
| Chronic Condition: | NULL | ||||||||
| Additional Gap Coverage: | Yes, some additional gap coverage. | ||||||||
| Maximum Out-of-Pocket Limit for Parts A & B (Moop): | $3,000 | ||||||||
| Annual Deductible: | NULL | ||||||||
| Annual Initial Coverage Limit ICL: | $4,130 | ||||||||
| Number of Members enrolled in this plan in Rio Arriba, New Mexico: | Plans Summary Star Rating: | Customer Service Rating: | Drug Cost Rating: | ||||||
| 28 members | 3.5 out of 5 Stars. | 4 out of 5 Stars. | 3 out of 5 Stars. | ||||||
| Plan Offers Mail Order: | Yes | ||||||||
| Plan Health Benefits | |||||||||
| Total # of Formulary Drugs: | 3,198 drugs | ||||||||
| Number of Members Enrolled in this Plan in Rio Arriba, New Mexico: | 3,105 members | ||||||||
| Number of Drugs Per Tier: | NULL | ||||||||
| Preferred Pharmacy Cost Sharing During Initial Coverage Phase: | NULL | ||||||||
| Special Needs Plan SNP Eligibility Requirement: | NULL | ||||||||
| Monthly Premium Split as Follows: | |||||||||
| Part C Premium | Part D Base Premium | Part D Supplemental Premium | Total Premium | ||||||
| $69.50 | $50.50 | $0.00 | $120.00 | ||||||
| Monthly Premium with Extra Help Low Income Subsidy: | |||||||||
| LIS100 Subsidy Total Monthly Premium with LIS Parts CD | LIS25 Subsidy Monthly PartD Premium with LIS | LIS25 Subsidy Total Monthly Premium with LIS Parts CD | LIS50 Monthly PartD Premium with LIS | LIS50 Subsidy Total Monthly Premium with LIS Parts CD | LIS75 Monthly PartD Premium with LIS | LIS75 Subsidy Total Monthly Premium with LIS Parts CD | |||
| $91.80 | $43.50 | $113.00 | $36.40 | $105.90 | $29.40 | $98.90 | |||
| Formulary Drug Details: | |||||||||
| Tier 1 # of Drugs per Tier | Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 2 # of Drugs per Tier | Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 3 # of Drugs per Tier | Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 4 # of Drugs per Tier | Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 5 # of Drugs per Tier | Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase) |
| 197 | $0.00 | 1229 | $10.00 | 527 | $45.00 | 577 | $95.00 | 668 | 33% |