Presbyterian Medicare Ppo Plan 1
by Presbyterian Insurance Company, Inc.
The Presbyterian Medicare Ppo Plan 1 by Presbyterian Insurance Company, Inc. offers Medicare Advantage Plans with additional benefits that Original Medicare does not cover. There are 1 different plans by Presbyterian Medicare Ppo Plan 1 available. Not all plans are available in all locations and prices may vary by location. The plan with the lowest monthly premium is $43 and the highest monthly premium is $43. The plan with the lowest out-of-pocket expense is $6700 and the highest out-of-pocket is $6700. You can review the table below to see coverage and prices for Presbyterian Medicare Ppo Plan 1.
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|Plan ID ⇅||Premium||Plan Type||MOOP||Members
H3206 003 0
|$43.00||Local PPO *||$6,700||136||New Mexico Part-C|
Contact Info Presbyterian Insurance Company, Inc.
Toll Free: 800-347-4766
Member Phone: 505-923-6060
Reviews for Presbyterian Medicare Ppo Plan 1
Presbyterian Medicare Ppo Plan 1 H3206 received a 3 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on quality and performance measures. You can use the CMS star rating to review performance among several different plans.
|Overall Rating||3 out of 5|
|Part C Summary Rating||2.5 out of 5|
|Part-D Summary Rating||3.5 out of 5|
|Staying Healthy: Screenings, Tests, Vaccines||3 out of 5|
|Managing Chronic (Long Term) Conditions||3 out of 5|
|Member Experience with Health Plan||2 out of 5|
|Complaints and Changes in Plans Performance||3 out of 5|
|Health Plan Customer Service||5 out of 5|
|Drug Plan Customer Service||5 out of 5|
|Complaints and Changes in the Drug Plan||4 out of 5|
|Member Experience with the Drug Plan||3 out of 5|
|Drug Safety and Accuracy of Drug Pricing||2 out of 5|
Staying Healthy, Screening, Testing, and Vaccines
Managing Chronic And Long Term Care for Older Adults
|Total Rating||3 out of 5|
|SNP Care Management ||NA out of 5|
|Medication Review ||NA out of 5|
|Pain Assessment ||N out of 5|
|Osteoporosis Management ||NA out of 5|
|Diabetes Care - Eye Exam ||3 out of 5|
|Diabetes Care - Kidney Disease ||2 out of 5|
|Diabetes Care - Blood Sugar ||3 out of 5|
|Controlling Blood Pressure ||2 out of 5|
|Reducing Risk of Falling ||2 out of 5|
|Improving Bladder Control ||4 out of 5|
|Medication Reconciliation ||2 out of 5|
|Statin Therapy ||2 out of 5|
Member Experience with Health Plan
Member Complaints and Changes in Plans Performance
Health Plan Customer Service Rating
Drug Plan Customer Service
|Total Rating||5 out of 5|
|Call Center, TTY, Foreign Language ||5 out of 5|
Ratings For Member Complaints and Changes in the Drug Plans Performance
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing
|Total Rating||2 out of 5|
|MPF Price Accuracy ||5 out of 5|
|Drug Adherence for Diabetes Medications ||1 out of 5|
|Drug Adherence for Hypertension (RAS antagonists) ||2 out of 5|
|Drug Adherence for Cholesterol (Statins) ||3 out of 5|
|MTM Program Completion Rate for CMR ||NA out of 5|
|Statin with Diabetes ||1 out of 5|
Breast Cancer Screening-Percent of female plan members aged 52-74 who had a mammogram during the past two years.
Colorectal Cancer Screening-Percent of plan members aged 50-75 who had appropriate screening for colon cancer.
Annual Flu Vaccine-Percent of plan members who got a vaccine (flu shot).
Monitoring Physical Activity-Percent of senior plan members who discussed exercise with their doctor and were advised to start, increase, or maintain their physical activity during the year.
SNP Care Management-This measure is defined as the percentage of eligible Special Needs Plan (SNP) enrollees who received a health risk assessment (HRA) during the measurement year.
Medication Review-Percent of plan members whose doctor or clinical pharmacist reviewed a list of everything they take (prescription and non-prescription drugs, vitamins, herbal remedies, other supplements) at least once a year.
Pain Assessment-Percent of plan members who had a pain screening at least once during the year.
Osteoporosis Management-Percent of female plan members who broke a bone and got screening or treatment for osteoporosis within 6 months.
Diabetes Care - Eye Exam-Percent of plan members with diabetes who had an eye exam to check for damage from diabetes during the year.
Diabetes Care - Kidney Disease-Percent of plan members with diabetes who had a kidney function test during the year.
Diabetes Care - Blood Sugar-Percent of plan members with diabetes who had an A1C lab test during the year that showed their average blood sugar is under control.
Controlling Blood Pressure-Percent of plan members with high blood pressure who got treatment and were able to maintain a healthy pressure.
Reducing Risk of Falling-Percent of plan members with a problem falling, walking, or balancing who discussed it with their doctor and received a recommendation for how to prevent falls during the year.
Improving Bladder Control-Percent of plan members with a urine leakage problem in the past 6 months who discussed treatment options with a provider.
Medication Reconciliation-This shows the percent of plan members whose medication records were updated within 30 days after leaving the hospital.
Statin Therapy-This rating is based on the percent of plan members with heart disease who get the right type of cholesterol-lowering drugs. Health plans can help make sure their members are prescribed medications that are more effective for them.
Getting Needed Care-Percent of the best possible score the plan earned on how quickly members get appointments and care.
Getting Appointments-Percent of the best possible score the plan earned on how easy it is for members to get information and help from the plan when needed.
Customer Service-Health Plan Provides Information or Help When Members Need It. Percent of the best possible score the plan earned on how easy it is for members to get information and help from the plan when needed.
Health Care Quality-Percent of the best possible score the plan earned from members who rated the quality of the health care they received.
Rating of Health Plan-Member's Rating of Health Plan Percent of the best possible score the plan earned from members who rated the health plan.
Care Coordination-Percent of the best possible score the plan earned on how well the plan coordinates members’ care. (This includes whether doctors had the records and information they needed about members’ care and how quickly members got their test results.)
Complaints about Health Plan-Patients’ Experience and Complaints Measure Complaints about the Health Plan (lower numbers are better because it means fewer complaints
Members Leaving the Plan-Percent of plan members who chose to leave the plan. Members Choosing to Leave the Plan (more stars are better because it means fewer members choose to leave the plan)
Health Plan Quality Improvement-Improvement (if any) in the Health Plan’s Performance. This shows how much the health plan’s performance improved or declined from one year to the next.
Timely Decisions About Appeals-Percent of appeals timely processed by the plan (numerator) out of all the plan‘s appeals decided by the Independent Review Entity (IRE) (includes upheld, overturned, partially overturned appeals and dismissed because the plan agreed to cover.)
Reviewing Appeals Decisions-This rating shows how often an independent reviewer found the health plan’s decision to deny coverage to be reasonable.
Call Center, TTY, Foreign Language-Percent of time that TTY services and foreign language interpretation were available when needed by people who called the health plan’s prospective enrollee customer service phone line.
Call Center, TTY, Foreign Language-Percent of time that TTY services and foreign language interpretation were available when needed by people who called the drug plan’s prospective enrollee customer service line.
Complaints about the Drug Plan-Complaints about the Drug Plan (number of complaints for every 1,000 members). Lower numbers are better because it means fewer complaints.
Members Choosing to Leave the Plan-Members Choosing to Leave the Plan lower percentages are better because that indicates fewer members choose to leave the plan.
Drug Plan Quality Improvement-This shows how much the drug plan’s performance has improved or declined from one year to the next year.
Rating of Drug Plan-Percent of the best possible score the plan earned from members who rated the prescription drug plan.
Getting Needed Prescription Drugs-Percent of the best possible score the plan earned on how easy it is for members to get the prescription drugs they need using the plan.
MPF Price Accuracy-A score comparing the drug’s total cost at the pharmacy to the drug prices the plan provided for the Medicare Plan Finder website.
Drug Adherence for Diabetes Medications-Percent of plan members with a prescription for diabetes medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication. One of the most important ways people with diabetes can manage their health is by taking their medication as directed. The plan, the doctor, and the member can work together to find ways to do this.
Drug Adherence for Hypertension (RAS antagonists)-Percent of plan members with a prescription for a blood pressure medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication.
Drug Adherence for Cholesterol (Statins)-Percent of plan members with a prescription for a cholesterol medication (a statin drug) who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication.
MTM Program Completion Rate for CMR-Some plan members are in a program (called a Medication Therapy Management program) to help them manage their drugs. The measure shows how many members in the program had an assessment of their medications from the plan. The assessment includes a discussion between the member and a pharmacist (or other health care professional) about all of the member’s medications.
Statin with Diabetes-This rating is based on the percent of plan members with diabetes who take the most effective cholesterol-lowering drugs. Plans can help make sure their members get these prescriptions filled.
Last updated on
Source:CMS Plan and Prices Info
Source:CMS Star Ratings