In-network
Inpatient hospital
inpatient coinsurance is selected but its percentage is missing
● CMS 2026 plan record
Presbyterian Dual Plus (HMO D-SNP)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network20% coinsurance
Air · in-network20% coinsurance
Emergency services
Emergency room
20% coinsurance
Waived if admitted within 24 hours
Medical maximum
Maximum out-of-pocket
In-network$9,250
Combined in + outNot reported
Skilled care at home
Home health
In-networkCost share not reported
Out-of-networkNot separately reported
Monthly cost
Premium & giveback
Part C premium$0 / month
Consolidated C + D$0 / month
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Primary care physician
In: 20% coinsurance · Out: Not separately reported
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Specialist
In: 20% coinsurance · Out: Not separately reported
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Preventive care
In: 20% coinsurance · Out: Not separately reported
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Diagnostic procedures & tests
In: 20% coinsurance · Out: Not separately reported
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Laboratory services
In: 20% coinsurance · Out: Not separately reported
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X-rays & standard imaging
In: 20% coinsurance · Out: Not separately reported
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MRI, CT & PET imaging
In: 20% coinsurance · Out: Not separately reported
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Urgent care
In: Cost share not reported · Out: Not separately reported
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Emergency room
In: 20% coinsurance · Out: Not separately reported
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Ground ambulance
In: 20% coinsurance · Out: Not separately reported
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Air ambulance
In: 20% coinsurance · Out: Not separately reported
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Outpatient hospital
In: 20% coinsurance · Out: Not separately reported
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Outpatient surgery / ASC
In: 20% coinsurance · Out: Not separately reported
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Home health
In: Cost share not reported · Out: Not separately reported
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Skilled nursing facility
In: Cost share not reported · Out: Not separately reported
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Cardiac & pulmonary rehabilitation
In: 20% coinsurance · Out: Not separately reported
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Occupational therapy
In: 20% coinsurance · Out: Not separately reported
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Physical & speech therapy
In: 20% coinsurance · Out: Not separately reported
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Mental health services
In: 20% coinsurance · Out: Not separately reported
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Substance use treatment
In: 20% coinsurance · Out: Not separately reported
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Podiatry
In: 20% coinsurance · Out: Not separately reported
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Chiropractic
In: Cost share not reported · Out: Not separately reported
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Dental
In: 20% coinsurance · Out: Not separately reported
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Vision
In: Cost share not reported · Out: Not separately reported
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Hearing
In: Cost share not reported · Out: Not separately reported
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Transportation
In: Cost share not reported · Out: Not separately reported
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Fitness & wellness
In: Cost share not reported · Out: Not separately reported
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Over-the-counter allowance
In: Cost share not reported · Out: Not separately reported
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Meals
In: Cost share not reported · Out: Not separately reported
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-network20% coinsurance
Out-of-networkNot separately reported
Specialist
In-network20% coinsurance
Out-of-networkNot separately reported
Preventive care
In-network20% coinsurance
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-network20% coinsurance
Out-of-networkNot separately reported
Laboratory services
In-network20% coinsurance
Out-of-networkNot separately reported
X-rays & standard imaging
In-network20% coinsurance
Out-of-networkNot separately reported
MRI, CT & PET imaging
In-network20% coinsurance
Out-of-networkNot separately reported
Urgent & hospital care6 benefits
Urgent care
In-networkCost share not reported
Out-of-networkNot separately reported
Emergency room
In-network20% coinsurance
Out-of-networkNot separately reported
Ground ambulance
In-network20% coinsurance
Out-of-networkNot separately reported
Air ambulance
In-network20% coinsurance
Out-of-networkNot separately reported
Outpatient hospital
In-network20% coinsurance
Out-of-networkNot separately reported
Outpatient surgery / ASC
In-network20% coinsurance
Out-of-networkNot separately reported
Recovery & therapy5 benefits
Home health
In-networkCost share not reported
Out-of-networkNot separately reported
Skilled nursing facility
In-networkCost share not reported
Out-of-networkNot separately reported
Cardiac & pulmonary rehabilitation
In-network20% coinsurance
Out-of-networkNot separately reported
Occupational therapy
In-network20% coinsurance
Out-of-networkNot separately reported
Physical & speech therapy
In-network20% coinsurance
Out-of-networkNot separately reported
Behavioral health2 benefits
Mental health services
In-network20% coinsurance
Out-of-networkNot separately reported
Substance use treatment
In-network20% coinsurance
Out-of-networkNot separately reported
Specialty care2 benefits
Podiatry
In-network20% coinsurance
Out-of-networkNot separately reported
Chiropractic
In-networkCost share not reported
Out-of-networkNot separately reported
Supplemental benefits7 benefits
Dental
In-network20% coinsurance
Out-of-networkNot separately reported
Vision
In-networkCost share not reported
Out-of-networkNot separately reported
Hearing
In-networkCost share not reported
Out-of-networkNot separately reported
Transportation
In-networkCost share not reported
Out-of-networkNot separately reported
Fitness & wellness
In-networkCost share not reported
Out-of-networkNot separately reported
Over-the-counter allowance
In-networkCost share not reported
Out-of-networkNot separately reported
Meals
In-networkCost share not reported
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview
Premium & Part B giveback
$0 Part C premium / month · Part B giveback not separately reported
Maximum out-of-pocket (MOOP)
In-network$9,250
Combined in + outNot reported
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Network & referrals
HMO · Referrals: Not required · Out-of-network coverage: No
Prescription drugs5 tiers
Part D deductible
Not reported
Drug tier 1
$0 retail copay · 30-day supply
Drug tier 2
25% retail coinsurance · 30-day supply
Drug tier 3
25% retail coinsurance · 30-day supply
Drug tier 4
25% retail coinsurance · 30-day supply
Drug tier 5
25% retail coinsurance · 30-day supply
Using this plan
Understand H3204-013-006
Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.
Plan at a glance
A quick read on this plan
Presbyterian Dual Plus (HMO D-SNP) is a 2026 HMO offered by Presbyterian Health Plan in Greater Non-Metro Region. The CMS record does not indicate routine out-of-network coverage. The plan record does not require referrals.
Common benefit costs
What you may pay
These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.
Routine care
- Primary care physician
- 20% coinsurance
- Specialist
- 20% coinsurance
- Laboratory services
- 20% coinsurance
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- 20% coinsurance
- MRI, CT & PET imaging
- 20% coinsurance
- Outpatient hospital
- 20% coinsurance
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- 20% coinsurance
Actual costs depend on the care received and plan rules.
Helpful context
Terms worth knowing
Maximum out-of-pocket (MOOP)
This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.
Availability
Who can enroll
- Service area
- Greater Non-Metro Region (NM)
- Plan type
- HMO
- Special Needs Plan
- Dual-Eligible
- Contract / plan
- H3204-013
- Coverage year
- 2026
This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area. Confirm eligibility and the exact service area with the plan before enrolling.
Supplemental coverage
Extra benefits reported
Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.
Dental20% coinsurance
VisionCost share not reported
HearingCost share not reported
Over-the-counter allowanceCost share not reported
Fitness & wellnessCost share not reported
TransportationCost share not reported
MealsCost share not reported
Plan-specific answers
Frequently asked questions
Where is H3204-013-006 available?
Presbyterian Dual Plus (HMO D-SNP) is listed for Greater Non-Metro Region (NM). This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.
What is the in-network maximum out-of-pocket limit for H3204-013-006?
The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $9,250. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H3204-013-006?
The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H3204-013-006?
The plan record lists 20% coinsurance, waived when an admission meets the plan's stated timing rule.
Does H3204-013-006 report extra benefits?
Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2026
Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.
Plan context
Where H3204-013-006 fits
- Full CMS plan ID
H3204-013-006- Contract
H3204- Base plan code
H3204-013- Segment
006- Carrier
- Presbyterian Health Plan
- Plan type
- HMO
- Service area
- Greater Non-Metro Region (NM)
County/service-area foundation
CMS service-area entries
Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.
- Catron, NM
- Cibola, NM
- Colfax, NM
- DeBaca, NM
- Eddy, NM
- Grant, NM
- Guadalupe, NM
- Harding, NM
- Hidalgo, NM
- Lea, NM
- Lincoln, NM
- Los Alamos, NM
10 additional service-area entries are retained in the data record.
About this code
What H3204-013-006 identifies
H3204-013-006 is a Contract Year 2026 Medicare plan segment code. Searches written as H3204-013, H3204 013, or the compact full CMS ID H3204013006 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.