Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H3204-013-004

Presbyterian Dual Plus (HMO D-SNP) · Presbyterian Health Plan · Counties: BER, DON, SDV, SFE & VAL

Compact plan code: H3204013004

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Presbyterian Dual Plus (HMO D-SNP)

H3204-013-004 Counties: BER, DON, SDV, SFE & VAL HMO Dual-Eligible
Open in quick lookup
01

In-network

Inpatient hospital

inpatient coinsurance is selected but its percentage is missing

02

Emergency transport

Ambulance

Ground · in-network20% coinsurance
Air · in-network20% coinsurance
03

Emergency services

Emergency room

20% coinsurance

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$9,250
Combined in + outNot reported
05

Skilled care at home

Home health

In-networkNo cost share reported
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$0 / month

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. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H3204-001-000 Presbyterian Senior Care Plan 2 with Rx (HMO) Counties: BER, CIB, RIO, SDV, SFE, SOC, TOR & VAL · HMO H3204-007-000 Presbyterian Senior Care Plan 3 with Rx (HMO) Greater Albuquerque Area, Rio Arriba and Santa Fe · HMO H3204-008-000 Presbyterian Senior Care Plan 1 (HMO) Greater Albuquerque Area, Rio Arriba and Santa Fe · HMO H3204-013-005 Presbyterian Dual Plus (HMO D-SNP) Counties: CHA, CUR, MCK, QUA, ROO & SJU · HMO H3204-013-006 Presbyterian Dual Plus (HMO D-SNP) Greater Non-Metro Region · HMO H3204-017-000 Presbyterian Senior Care Extra Health Plan with Rx (HMO) Counties: BER,CIB,RIO,SDV,SFE,SOC,TOR & VAL · HMO H3204-801-000 Presbyterian Senior Care Emp Group Plan 1 with Rx (HMO) Greater Albuquerque Area, Rio Arriba and Santa Fe · HMO H3204-802-000 Presbyterian Senior Care Emp Group Plan 2 (HMO) Greater Albuquerque Area, Rio Arriba and Santa Fe · HMO

About this code

What H3204-013-004 identifies

H3204-013-004 is a Contract Year 2026 Medicare plan segment code. The compact form H3204013004 refers to the same normalized contract, plan, and segment shown on this page.

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.