Medicare Advantage Plan HMO H3407_001

El Paso Health Medicare Advantage Dual (HMO D-SNP)

$0.00
Monthly Premium
$8,500
Maximum out-of-pocket
Enroll Now
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General Costs
Premium & Deductibles
In-Network
Monthly Plan Premium
$0
Medical Deductible
$0
Maximum Out-of-Pocket
$8,500
Pharmacy (Part D) Deductible
$0
The out-of-pocket maximum is the maximum amount that you will be required to pay a year for deductibles, copayments, and coinsurance on covered services.
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Doctor Costs & Coverage
Covered Doctor Copays
In-Network
Primary Care Copay
$0 copay
Specialist copay
$0 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.
Initial Coverage Stage
Copays will depend on the level of LIS the Member qualifies for.
Group 1
$1.60 - $4.90 copay
Group 2
$4.80 - $12.15 copay
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Hospital & X-Ray Costs
Hospital & Urgent Care
In-Network
Inpatient Hospital Care
$0 copay per day for day 1 to 90
Our plan also covers 60 “lifetime reserved days.” These are "extra” days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days.
Outpatient Hospital Care
$0 copay
Ambulatory Surgical Center (ASC) Service
$0 copay
Emergency Care
$0 copay
Urgent Care
$0 copay
Urgently needed services are provided to treat a non-emergency, unforeseen medical illness, injury or condition that requires immediate medical attention.
Labs & X-Rays
In-Network
Cost share may vary depending on the service and where service is provided.
Diagnostic Procedures/Tests
$0 copay
Lab Services
$0 copay
Diagnostic Radiological Services
$0 copay
X-Ray Services
$0 copay

Primary Benefits

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Mental Health Services
Mental Health Services
In-Network
Inpatient Care at a Psychiatric Facility
$0 copay per day for day 1 to 190
Your plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital.
Outpatient Mental Group Therapy
$0 copay
Outpatient Mental Individual Therapy Visit
$0 copay
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Dental Coverage
Dental Benefits
In-Network
Medicare-covered dental services
$0 copay
Routine Dental
In-Network
Oral exam(s) and Cleanings(s) every year
$0 copay
Dental X-ray(s) every year
$0 copay
Fluoride treatment(s) every year
$0 copay
Comprehensive Dental Services
In-Network
Diagnostic Services
$0 copay
Oral/Maxillofacial surgery
$0 copay
Extractions and Fillings
$0 copay
Implants and Dentures
$0 copay
Maximum benefit
$3,500
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Vision Coverage
Vision Benefits
In-Network
Additional vision benefits may be available with or without a separate monthly premium. For more information see the Summary of Benefits.
Medicare-covered Vision Services
$0 copay
Diabetic Eye Exam
$0 copay
Glaucoma Screening
$0 copay
Eyewear (Post Cataract Surgery)
$0 copay
Routine Vision
In-Network
Routine Exam up to 1 per year
$0 copay
Contact lenses or eyeglasses-lenses and frames up to 1 pair(s) per year
$0 copay
Fitting for eyeglasses-lenses and frames up to 1 per year
$0 copay
Refraction up to 1 per year
$0 copay
Max benefit: contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames
$400 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
$0 copay
Routine Hearing
In-Network
Routine Hearing Exam up to 1 per year
$0 copay
Hearing aid once every 2 years
$0 copay
Benefit Maximum:
Hearing aid device every two (2) years
$2,000 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:
‍
Abdominal aortic aneurysm screening
Colorectal cancer screenings (Colonoscopy, Fecal occult blood test, Flexible sigmoidoscopy)
Sexually transmitted infections screenings and counseling
Alcohol misuse counseling
Depression screenings
Tobacco use cessation counseling (counseling for people with no sign of tobacco related disease)
Bone mass measurement
Diabetes screenings
Flu shots
Breast cancer screening (mammogram)
HIV screenings
Hepatitis B shots
Cardiovascular disease (behavioral screenings)
Medical nutrition therapy services
Pneumococcal shots
Cardiovascular screenings
Obesity screening and counseling
“Welcome to Medicare” Preventive visit (one time)
Cervical and vaginal cancer screening
Pap smears and pelvic exams (women)
Yearly “Wellness” visit

2026 Supplemental Benefits

For a complete list of 2026 supplemental benefits, including full details and restrictions, please visit the D-SNP Supplemental Benefits page.
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Health and Home Program
Eligible members with a qualifying chronic condition can receive a $450 quarterly allowance to help cover the cost of healthy food or essential utilities like gas, water, electricity, or rent. This benefit supports better health by easing financial stress and making it easier to maintain a stable, nutritious lifestyle.
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Get Fit Program
Members get a monthly membership to any local YMCA facility or Planet Fitness center. Members must call Member Service and specify the fitness center they prefer. Members who choose any Planet Fitness will receive a monthly premium (black card) membership to any local Planet Fitness center.
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OTC Card
With up to $200 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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Transportation
With 96 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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PERS Device (Personal Emergency Response System Device)
A Personal Emergency Response System (PERS) device provides quick, one-touch access to emergency assistance, helping members stay safe and independent at home or on the go. Whether you've fallen, feel disoriented, or are experiencing shortness of breath, help is always within reach.
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Podiatry
Get up to 10 routine podiatry visits a year so you can keep your feet healthy and comfortable with preventive care and maintenance.
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Vision
Take advantage of up to $400 annually for routine eye exams and eyewear—so you can see clearly and protect your vision.
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Hearing
Receive up to $2,000 toward hearing evaluations and hearing aids every two years to help you stay engaged in conversations and daily life.
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Dental
Enjoy up to $3,000 a year in dental coverage for cleanings, x-rays, fillings, extractions and more—so your smile stays healthy from preventive care to restorative services.
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Home-Delivered Meals
After a hospital or nursing facility stay, enjoy up to 14 nutritious meals delivered to your home to support your recovery.
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24-Hour Nurse Line
Access bilingual medical advice 24/7 from nurses and pharmacists, anytime you need trusted health guidance.

Plan Documents

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2026 Plan Documents (Updated 10/01/2025 unless noted otherwise)
Summary of Benefits (CMS Approved 08/03/2025)
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
Enrollment Form (CMS Accepted 07/21/2025)
Complete enrollment by filling out this form.
English Spanish
Printable Prescription Drug List
View our Comprehensive Formulary
CMS Rating (CMS Accepted 09/18/2024)
A CMS Star Rating is a 1–5 scale used by Medicare to measure the quality and performance of D-SNP plan.
Annual Notice of Change (CMS Accepted 08/23/2025)
View our 2026 plan benefit changes.
English Spanish
Evidence of Coverage
See what's covered, and what you pay as a member of this plan.
English
Enroll Now

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1-833-742-3125
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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
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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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