2026 New Mexico Medicare Advantage Plans
New Mexico 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 Plan Premium | $0 | $0 |
| Part B Premium Rebate | N/A | $125 |
| Annual Out-of-Pocket Maximum | $4,200 | $4,900 |
Medical Services
| Service | Medicare Plus (HMO) H1189-002 | Medicare Guardian (HMO) H1189-007 |
|---|---|---|
| Inpatient Hospital Care | $150 per day (days 1–5), $0 per day (days 6-90) | $150 per day (days 1–5), $0 per day (days 6-90) |
| Primary Care (PCP) Office Visit | $0 (includes telehealth) | $0 (includes telehealth) |
| Specialist Office Visit | $25 | $35 |
| Emergency Care (Worldwide) | $150 | $130 |
| Routine Blood Tests | $0 | $0 |
| Diagnostic Radiology | $150 | $150 |
Hearing, Dental, and Vision
| Benefit | Medicare Plus (HMO) H1189-02 | Medicare Guardian (HMO) H1189-007 |
|---|---|---|
| Routine Hearing Exam | $0 (one per year) | $0 (one per year) |
| Prescription Hearing Aids | $395 – $1,595 copay per year | $395 – $1,595 copay per year |
| Combined Preventive and Comprehensive Annual Dental Allowance | $2,000 | $2,000 |
| Routine Dental Cleaning | $0 (up to three per year) | $0 (up to three per year) |
| Comprehensive Dental Benefit | $20 copay | $20 copay |
| Routine Eye Exam | $0 (one per year) | $0 (one per year) |
| Eyewear | $300 per year | $250 per year |
Additional Benefits
| Benefit | Medicare Plus (HMO) H1189-02 | Medicare Guardian (HMO) H1189-007 |
|---|---|---|
| Durable Medical Equipment (DME) | 0% – 20% | 0% – 20% |
| Diabetic Supplies | $0 | $0 |
| Silver&Fit Fitness Program | $0 membership fee | $0 membership fee |
| OTC Allowance (per quarter) | $150 allowance each quarter | $75 allowance each quarter |
| Acupuncture & Alternative Therapy | $0 at CHRISTUS St. Vincent; $45 per visit (up to 4 per year) elsewhere | $0 at CHRISTUS St. Vincent; $45 per visit (up to 4 per year) elsewhere |
| Transportation | 48 one-way trips to medical appointments | 48 one-way trips to medical appointments |
| Post-Discharge Meals | Up to 14 home-delivered meals for up to 7 days | Up to 14 home-delivered meals for up to 7 days |
Prescription Drug Coverage
| Tier | Medicare Plus (HMO) H1189-002 | Medicare Guardian (HMO) H1189-007 |
|---|---|---|
| Part D Deductible: | $0 (Tiers 1, 2, & 6) $250 (Tiers 3-5) |
No prescription drug coverage |
| Tier 1: Preferred Generic Drugs |
Retail: $0 (30-day supply) Mail order $0 (100-day supply) |
|
| Tier 2: Generic Drugs |
Retail: $5 (30-day supply) Mail order: $10 (100-day supply) |
|
| Tier 3: Preferred Brand Name Drugs |
Retail: 25% of the cost. No more than $35 for covered insulin products. (30-day supply) Mail Order: 25% of the cost. No more than $105 for covered insulin products. (100-day supply) |
|
| Tier 4: Non-Preferred |
Retail: 30% of the cost. No more than $35 for covered insulin products. (30-day supply) Mail Order: 30% of the cost. No more than $105 for covered insulin products. (100-day supply) |
|
| Tier 5: Specialty |
Retail: 30% of the cost. No more than $35 for covered insulin products. (30-day supply) Mail Order: Not Covered. |
|
| Tier 6: Select Care |
Retail: $0 (30-day supply) Mail Order: $0 (100-day supply) |
|
| Coverage Gap | No coverage gap | |
| Catastrophic Coverage | After yearly out of pocket drug costs (retail and mail order) reaches $2,100. No additional costs for Part D drugs once member reaches $2,100. | |
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.
*For agent/broker use only. Subject to change pending CMS approval. Publicly sharing these benefits must not occur prior to Oct. 1, 2025.