Medicare Advantage Plan HMO H3407_002

El Paso Health Total (HMO)

A value plan that has health, dental, vision, and hearing care at a low premium.
This plan have prescription drug benefits.
$0.00
Monthly Premium
$4,000
Maximum out-of-pocket
How to Enroll
Medicare Annual Enrollment begins on October 15. Starting on this date, you can enroll in one of our Medicare Advantage plans that include prescription drug coverage.
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General Costs
Premium & Deductibles
In-Network
Monthly Plan Premium
$0
Medical Deductible
$0
Maximum Out-of-Pocket
$4,000
The maximum out of pocket is the amount that you will pay in deductibles, co-payments, and coinsurance on covered services. It does not include the amount you pay for monthly premiums.
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Doctor Costs & Coverage
Covered Doctor Copays
In-Network
Primary Care Copay
$0 copay
Specialist copay
$25 copay
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Prescription Drug Costs & Coverage
The cost of your medicine depends on where you buy it, how much you get and whether it is a generic, brand or specialty drug. For more details, see the pharmacy chart in the Summary of Benefits.
Prescription Drug Costs
Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$0 copay
Tier 3 - Preferred Brand
$35 copay
Tier 4 - Non-Preferred Drug
35% coinsurance
Tier 5 - Specialty Drugs
28% coinsurance
Tier 6 - Supplemental Drugs
$0 copay
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Hospital & X-Ray Costs
Hospital & Urgent Care
In-Network
Inpatient Hospital Care
$100 copay per day for day 1 to 5
$0 copay per day for day 6 to 90
Outpatient Hospital Facility Services
$150 copay
Emergency Room
$140 copay
If you are admitted to the same hospital within 24 hours, you do not have to pay your share of the cost for the emergency care.
Urgent Care
$50 copay
Urgently needed services are provided to treat a non-emergency, unforeseen medical illness, injury or condition that requires immediate medical attention.
Radiology & X-Rays
In-Network
Cost share may vary depending on the service and where service is provided.
Radiology Services In-Office
$165 copay
Radiology Services in a Facility
$320 copay
Outpatient X-Ray In-Office
$0 copay
Outpatient X-Ray in a Facility
$125 copay

Primary Benefits

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Mental Health Services
Mental Health Services
In-Network
Inpatient Hospital Psychiatric
Days 1-5       $100 copay per day
Days 6-90     $0 copay per day
Authorization is required for this service.
Mental health therapy visits
$25 for individual sessions
$25 group session
Outpatient substance abuse services
$25 for individual sessions
$25 group session
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Dental Coverage
Dental Benefits
In-Network
Medicare-covered dental services
$25 copay
Routine Dental
In-Network
Bitewing x-rays up to 1 set(s) per year  
$0 copay
Comprehensive oral evaluation or periodontal exam up to 1 every 3 years
$0 copay
Periodic oral exam up to 2 per year
$0 copay
Prophylaxis (cleaning) up to 2 per year
$0 copay
Amalgam and/or composite filling up to unlimited per year
$0 copay
Necessary anesthesia with covered service up to unlimited per year
$0 copay
Simple or surgical extraction up to unlimited per year 
$0 copay
Maximum benefit
$1,500 maximum benefit coverage amount per year
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Vision Coverage
Vision Benefits
In-Network
Additional vision benefits may be available. For more information see the Summary of Benefits.
Medicare-covered Vision Services
$25 copay
Routine Vision
In-Network
Routine Exam up to 1 per year
$0 copay
Max benefit: contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames
$200 maximum benefit coverage amount per year
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Hearing Coverage
Hearing Benefits
In-Network
Additional hearing benefits may be available with a separate monthly premium. For more information see the Summary of Benefits.
Medicare-covered Hearing Services
$25 copay
Routine Hearing
In-Network
Entry level hearing aid once every 2 years
$525 copay
Basic level hearing aid once every 2 years
$700 copay
Premium level hearing aid once every 2 years
$1,000 copay
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Preventative Coverage
Preventative Benefits
In-Network
In-network: $0 for the following preventive services when you see an in-network provider:
‍
Bone mass measurement
Cervical and vaginal cancer screening
Medicare diabetes prevention program (MDPP)
Annual wellness visit
Colorectal cancer screening
Prostate cancer screening
Breast cancer screening (mammogram)
Diabetes screenings
Routine physical exam
Cardiovascular screenings
Immunizations
Lung cancer screening

Supplemental Benefits

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Transportation
With 12 one-way non-emergent medical transportation services each year, members can get to important healthcare appointments without worrying about how they’ll get there. This benefit supports access to routine doctor visits, lab tests, dialysis, and more—helping you stay on top of your health.
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OTC Card
With up to $45 each quarter for eligible over-the-counter and hygiene products, this benefit helps members afford everyday health essentials like pain relievers, cold medicine, and personal care items. The allowance renews every quarter, making it easier to manage health needs year-round without extra out-of-pocket costs.
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Get Fit Program
El Paso Health members can enjoy a cost-free Black Card membership at any Planet Fitness location, just show your member ID at the front desk. This benefit supports your fitness and well-being with access to top gym amenities at no extra cost.

Plan Documents

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2026 Plan Documents (Updated 10/01/2025 unless noted otherwise)
Summary of Benefits (CMS Accepted 08/30/2025)
View deductibles, copays, and more.
English Spanish
Provider Directory
Search the Provider Directory on El Paso Health's non-Medicare website or view and download the pdf below.
List of Providers
Pharmacy Directory
View our network of Pharmacies
English Spanish
Enrollment Form (CMS Accepted 06/09/2025)
Complete enrollment by filling out this form.
English Spanish
Printable Prescription Drug List
View our Comprehensive Formulary
Evidence of Coverage (Disclaimer– Coming Soon)
See what's covered, and what you pay as a member of this plan.
How to Enroll

Licensed sales agents are here to answer your questions.

Find a plan that best suits your needs in just one phone call.
1-833-742-2121
TTY 711, 24/7
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1145 Westmoreland Drive
El Paso, TX 79925-5615

El Paso Health Medicare Advantage Dual (HMO D-SNP)
1-833-742-3125

El Paso Health Giveback (HMO)
El Paso Health Total (HMO)
‍1-833-742-2121

See Hours of Operation here.
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The information posted on this website may be available in other formats such as large print, Braille, and audio. You can request the materials in other formats by calling Member Services.
Last Updated: 10/01/2025
Member Support
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General Correspondence
P.O. Box 971100
El Paso, TX 79997-1100
You can also report fraud, waste and abuse directly to the Texas Office of Inspector General.
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