CHRISTUS Health Medicare Plan Comparison – New Mexico (2025)
CHRISTUS Health Medicare Plan Comparison – New Mexico (2025)
Counties: Bernalillo, Los Alamos, Otero, Rio Arriba, Sandoval, San Miguel, Santa Fe, and Taos
Plan Overview
| Benefit |
Medicare Plus (HMO) H1189-002 |
Medicare Guardian (HMO) H1189-007 |
| Monthly Premium |
$0 |
$0 |
| Part B Rebate |
N/A |
$125 |
| Annual Out-of-Pocket Maximum |
$4,000 |
$4,900 |
Medical Services
| Service |
Plus |
Guardian |
| Inpatient Hospital Care |
$150/day (days 1–5), $0/day (days 6+) |
$150/day (days 1–5), $0/day (days 6+) |
| Primary Care Visit |
$0 (includes telehealth) |
| Specialist Visit |
$25 |
$25 |
| Emergency Care (Worldwide) |
$125 |
$125 |
| Routine Blood Tests |
$0 |
| Diagnostic Radiology |
$150 |
$150 |
Hearing, Dental, and Vision
| Benefit |
Plus |
Guardian |
| Routine Hearing Exam |
$0 (one per year) |
| Hearing Aids |
$395 – $1,595 copay per ear/year |
| Dental Annual Allowance |
$2,000 |
$2,000 |
| Dental Cleaning |
$0 (up to three per year) |
| Comprehensive Dental |
$20 copay |
| Routine Eye Exam |
$0 (one per year) |
| Eyewear |
$300/year |
$250/year |
Additional Benefits
| Benefit |
Plus |
Guardian |
| Durable Medical Equipment (DME) |
0% – 20% |
0% – 20% |
| Diabetic Supplies |
$0 |
| Silver&Fit Fitness Program |
$0 membership fee |
| OTC Allowance (per quarter) |
$205 |
$75 |
| Acupuncture & Alternative Therapy |
$0 at CHRISTUS St. Vincent; $45 per visit (up to 4/year) elsewhere |
| Transportation |
48 one-way trips to medical appointments |
| Post-Discharge Meals |
Up to 14 meals for up to 7 days |
Prescription Drug Coverage
| Tier |
Retail (30-Day) |
Mail Order (90-Day) |
| Tier 1: Preferred Generic |
$0 |
$0 |
| Tier 2: Generic |
$5 |
$0 |
| Tier 3: Preferred Brand |
$47 |
$141 |
| Tier 4: Non-Preferred |
$100 |
$300 |
| Tier 5: Specialty |
33% |
Not Covered |
| Tier 6: Select Care |
$0 |
$0 |
| Coverage Gap |
No coverage gap |
| Catastrophic Coverage |
No costs after $2,000 annual out-of-pocket on Part D drugs |
Contact & Legal
Contact: 844.282.3026 / TTY 711
Open daily from Oct 1 – Mar 31 (8 a.m. to 8 p.m.), and Mon – Fri from Apr 1 – Sept 30 (8 a.m. to 8 p.m.). After-hours messages will be returned the next business day.
CHRISTUS Health Advantage is an HMO with a Medicare contract. Enrollment depends on contract renewal. Benefits, premiums, copays, and networks may change annually. Contract #H1189.
