Presbyterian Medicare Advantage Plans New Mexico 2025
Choosing Medicare Advantage in New Mexico means evaluating your options carefully, including Presbyterian Medicare Advantage Plans in New Mexico. With these plans, you gain not only essential healthcare coverage but also benefits that make a difference, like $0 copays and an $860 flex card.
In this article, we’ll delve into the specifics, helping New Mexicans understand their Medicare Advantage choices without sales pressure or unnecessary detail.
Key Takeaways
- Presbyterian Medicare Advantage Plans offer enhanced healthcare benefits in 2025, including $0 primary care visits, coverage for telehealth, prescription drugs, and over-the-counter allowances with plans tailored to different needs like PPO, HMO-POS, and Dual Plus.
- The plans come with additional lifestyle benefits such as a comprehensive dental plan, coverage for hearing aids, and free membership to the SilverSneakers Fitness program, promoting overall wellness.
- For peace of mind when traveling, Assist America provides global emergency travel assistance as part of the plan’s benefits, ensuring members have coverage for emergency and urgent care anywhere in the world.
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Understanding Presbyterian Medicare Advantage Plans in New Mexico
Redefining health coverage, Presbyterian Medicare Advantage Plans in New Mexico provide more benefits than Original Medicare, thereby enhancing the accessibility and affordability of healthcare.
These plans come with an $860 flex card with the UltraFlex plan, which can be used to pay for various health services.
But that’s just the tip of the iceberg. Participants in these plans reap the benefits of:
- $0 primary care visits
- Telehealth services with in-network providers, specialists, and urgent care included
- $0 deductible for prescription drugs
- Preferred generic drugs available with $0 copays on HMO Plans 2 and 3
Presbyterian Medicare PPO
With the Presbyterian Medicare PPO plan, you can select any Medicare-accepting provider, whether in or out of the network. The eligibility criteria for this plan are simple.
You qualify if you hold entitlement to Medicare Part A, are enrolled in Medicare Part B, and reside in New Mexico.
Remember that while you can choose non-contracted dental providers, you would likely incur higher out-of-pocket expenses.
The good news is that there are $0 monthly premium options available with the Presbyterian Medicare Advantage PPO plans, making it an affordable choice for many.
HMO POS Plan
The Presbyterian UltraFlex (HMO-POS) Plan offers the following benefits:
- $860 flex card for over-the-counter drugs and other needs
- Free primary care visits and telehealth consultations with PCPs, specialists, and urgent care
- Eligible for residents of specific New Mexico counties, including Santa Fe
A significant benefit of this plan is:
- The option to select providers outside the network for a flat copay
- Basic dental coverage
- Two hearing aids per year (one per ear) at no copay
- A free SilverSneakers Fitness membership, granting access to over 15,000 fitness locations nationwide.
Presbyterian Dual (HMO D-SNP)
Designed specifically for individuals who are eligible for both Medicare and Medicaid, the Presbyterian Dual Plus (HMO D-SNP) Plan provides coverage and benefits structured to meet the needs of dual-eligible members.
Key features of the plan include:
- Dedicated support is available from 8 a.m. to 8 p.m., Sunday to Saturday
- Comprehensive coverage for medical services, prescription drugs, and more
- Access to a network of doctors, specialists, and hospitals
- Additional benefits such as dental, vision, and hearing coverage
With the Presbyterian Dual Plus Plan, you can have peace of mind knowing that you have assistance and coverage when you need it.
Members of this plan enjoy:
- Comprehensive dental coverage with $3,000 in routine dental services annually
- A hearing aid allowance of up to $2,000 every two years
- A transportation benefit that includes 50 one-way rides annually to healthcare providers, dentists, or pharmacies.
More Benefits: Enhancing Your Original Medicare Coverage
Offering additional benefits, Presbyterian Medicare Advantage plans enhance your coverage beyond Original Medicare.
Some of the substantial benefits include:
- Prescription drug coverage
- Vision and dental coverage
- Fitness and wellness programs
- Transportation services
- Over-the-counter allowances
These benefits can make a significant difference in your healthcare experience.
Consider the convenience of having a visit for:
- primary care visits
- dental services
- vision services
- telehealth services
All with a $0 copay. Or the financial flexibility of a flex spending card and out-of-network benefits with a flat copay through the HMO-POS Plan. This is the kind of enhanced coverage that these plans bring to the table.
Dental Coverage Options
Basic dental coverage, which includes:
- oral exams
- cleanings
- fluoride treatments
- emergency minor pain treatment
is included at no additional cost in all Presbyterian Medicare Advantage plans. But if you want to step up your dental care, you have the option to enroll in a Comprehensive Dental Plan for an added monthly premium. This plan expands your coverage with a $4,000 calendar-year benefit maximum and omits the need for prior authorization for covered services.
However, it’s worth noting that certain services like implants, cosmetic procedures, bone grafts, and tissue regeneration are excluded from the Comprehensive Dental Plan. So, it’s essential to consider your specific dental needs before choosing a plan.
Hearing Aid Coverage and Care
Good hearing is essential for quality of life, and Presbyterian Medicare Advantage plans have got you covered. They offer a routine annual hearing exam with no copay required. But that’s not all.
You also get coverage for up to two hearing aids per year, with one hearing aid for each ear being covered annually.
If you’re a member of the Dual Plus plan, you even get up to a $2,000 allowance every two years for hearing aids in addition to the $0 hearing screening.
SilverSneakers® Fitness Program
Fitness is an integral part of staying healthy, and Presbyterian Medicare Advantage plans recognize this by including the SilverSneakers Fitness program at no additional cost.
With this program, you get a free SilverSneakers Fitness membership, which provides access to over 15,000 gyms nationwide, including popular chains like Planet Fitness and YMCA. This program aims to improve your physical health by providing a variety of exercise options suitable for all fitness levels.
Travel with Confidence: Assist America® Protection
Acknowledging that medical emergencies can occur anytime, anywhere, Presbyterian Medicare Advantage plans provide appropriate measures. That’s why they’ve partnered with Assist America to provide global emergency travel assistance services.
Whether you’re traveling 100 miles away from home or in a foreign country, these services are there to help during medical emergencies.
So, you can travel with confidence, knowing that you and your family are covered for emergency and urgent care no matter where you are in the world.
Comparing Presbyterian Medicare Advantage Plans
Healthcare coverage is not a one-size-fits-all solution. That’s why Presbyterian Health Plan offers both HMO and PPO Medicare Advantage plans. While the HMO plans give you access to a network of Presbyterian doctors and specialists, the PPO plans offer more freedom to choose providers.
All plans include a $0 cost for primary care visits and offer telehealth services at no additional cost.
However, the Presbyterian UltraFlex Medicare Advantage Plan stands out by offering an $860 flex card that can be used for dental, hearing, vision services, and more. It’s all about finding the plan that best suits your individual circumstances.
How to Enroll in a Presbyterian Medicare Advantage Plan
Qualifying for a Presbyterian Medicare Advantage plan is pretty simple. To qualify, you must have entitlement to Medicare Part A and enrollment in Medicare Part B. These criteria are necessary for eligibility.
However, some plans like the Presbyterian Dual Plus (HMO D-SNP) and Presbyterian Senior Care (HMO) require additional eligibility based on specific categories of Medicaid coverage or residency in certain New Mexico counties.
The Importance of Presbyterian Senior Care
Presbyterian Senior Care acknowledges that healthcare needs to progress as we age. They focus on senior healthcare needs, offering various services tailored to the aging community.
Their programs address common senior health concerns such as chronic disease management and medication adherence.
They also provide a multidisciplinary team of healthcare professionals to provide a holistic approach to senior care, ensuring that care is accessible and coordinated across different healthcare settings.
Summary
If you’ve come this far, you now know that Presbyterian Medicare Advantage Plans in New Mexico offer comprehensive healthcare coverage that goes beyond Original Medicare.
These plans not only cover your basic medical needs but also offer additional benefits like $0 copay services, a flex spending card, and global emergency travel assistance.
Every plan is designed with your healthcare needs in mind, whether you prefer the flexibility of a PPO, the comprehensive coverage of an HMO, or a plan that combines the benefits of both Medicare and Medicaid. So, why settle for less when you can have more with a Presbyterian Medicare Advantage Plan?
Frequently Asked Questions
→ What is the difference between a Medicare Advantage PPO plan and a Medicare Advantage HMO plan?
The main difference between a Medicare Advantage PPO plan and a Medicare Advantage HMO plan is the cost structure. HMO plans generally have lower monthly premiums, while PPO plans offer more flexibility in choosing providers.
→ Does New Mexico have Medicare Advantage plans?
Yes, New Mexico does have Medicare Advantage plans available, with nearly 49% of Medicare beneficiaries in the state enrolled in these plans. The availability varies by county, ranging from seven to more than 50 plans for 2023.
→ What is the most highly rated Medicare Advantage plan?
The most highly rated Medicare Advantage plan for 2025 features high Medicare star ratings, an extensive provider network, and a wide range of options to suit various needs. This plan stands out for its comprehensive coverage and customer satisfaction.
→ What are the benefits of Presbyterian Medicare Advantage Plans?
Presbyterian Medicare Advantage Plans offer additional benefits such as $0 copay services, a flex spending card, and coverage for services like dental, vision, and telehealth, providing comprehensive and affordable healthcare options.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.