2026 South Texas Medicare Advantage Plans
South Texas Counties: Aransas, Bee, Jim Wells, Kleberg, Nueces, Refugio, San Patricio
Plan Overview
| Benefit | Medicare Plus (HMO) H1189-005 | Medicare Guardian (HMO) H1189-008 |
|---|---|---|
| Monthly Premium | $0 | $0 |
| Part B Premium Rebate | N/A | $125 |
| Annual Max Out-of-Pocket | $4,000 | $4,900 |
Medical Services
| Service | Medicare Plus (HMO) H1189-005 | Medicare Guardian (HMO) H1189-008 |
|---|---|---|
| Inpatient Hospital Care | $0 per day (days 1–90+) | $0 per day (days 1–90+) |
| Primary Care (PCP) Office Visit | $0 (includes telehealth) | $0 (includes telehealth) |
| Specialist Office Visits | $25 | $40 |
| Emergency Care (Worldwide) | $150 | $130 |
| Routine Blood Tests | $0 | $0 |
| Diagnostic Radiology | $125 | $150 |
Dental, Vision & Hearing
| Benefit | Medicare Plus (HMO) H1189-005 | Medicare Guardian (HMO) H1189-008 |
|---|---|---|
| Routine Hearing Exam | $0 (1 per year) | $0 (1 per year) |
| Hearing Aids | $395–$1,595 copay per year | $395–$1,595 copay per year |
| Dental Allowance | $3,000 per year | $2,500 per year |
| Dental Cleaning | $0 (up to 3 per year) | $0 (up to 3 per year) |
| Comprehensive Dental | $20 copay | $20 copay |
| Eye Exam | $0 (1 per year) | $0 (1 per year) |
| Eyewear Allowance | $250 per year | $250 per year |
Additional Benefits
| Benefit | Medicare Plus (HMO) H1189-005 | Medicare Guardian (HMO) H1189-008 |
|---|---|---|
| Durable Medical Equipment | 0% - 20% | 0%–20% |
| Diabetic Supplies | $0 | $0 |
| Fitness (Silver&Fit) | $0 membership | $0 membership |
| OTC Allowance (Quarterly) | $125 | $75 |
| Transportation (Medical) | 48 one-way trips | 48 one-way trips |
| 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) H1189-005 | Medicare Guardian (HMO) H1189-008 |
|---|---|---|
| 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: $0 (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. Limitations, copayments, and restrictions may apply. Benefits and costs may change on Jan 1 each year.
*For agent/broker use only. Subject to change pending CMS approval. Publicly sharing these benefits must not occur prior to Oct. 1, 2025.