Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
Presbyterian Dual Plus, 2027
H3204Contract013Plan
HMO D-SNP · special needs plan, dual-eligible · 33 counties in New Mexico
Run by Presbyterian Health Plan (contract H3204), sold as Presbyterian Health Plan, owned by Presbyterian Healthcare Services
Presbyterian Dual Plus (H3204-013) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $9,850 ($8,500 to $9,250 in 2026). It takes in the members of H3204-017.
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| In-network out-of-pocket limit, by county | $8,500 to $9,250 | $9,850 | ▲up $600 at the top |
| Drug deductible | $550 | $700 | ▲up $150 |
| Drug tier 2, generic | 25% of the cost | $6.80 | changed |
| 18 lines do not change | |||
| Monthly premium | $0 | $0 | no change |
| Part B premium reduction, monthly (best in its area) | none | none | no change |
| Primary care visit (best in its area) | 20% of the cost | 20% of the cost | no change |
| Specialist visit (best in its area) | 20% of the cost | 20% of the cost | no change |
| Emergency room (best in its area) | 20% of the cost | 20% of the cost | no change |
| Medical deductible, in network (best in its area) | none | none | no change |
| Hospital stay, in network (best in its area) | not filed | not filed | no change |
| Skilled nursing facility, in network (best in its area) | not filed | not filed | no change |
| Ground ambulance, in network (best in its area) | 20% of the cost | 20% of the cost | no change |
| Comprehensive dental, yearly limit (best in its area) | not offered | not offered | no change |
| Eyewear, yearly limit (best in its area) | $275 a year | $275 a year | no change |
| Hearing aids, yearly limit for both ears (best in its area) | $1,000 a year | $1,000 a year | no change |
| Over-the-counter items, yearly (best in its area) | $660 a year | $660 a year | no change |
| Counties served | 33 | 33 | no change |
| Drug tier 1, preferred generic | $0 | $0 | no change |
| Drug tier 3, preferred brand | 25% of the cost | 25% of the cost | no change |
| Drug tier 4, non-preferred drug | 25% of the cost | 25% of the cost | no change |
| Drug tier 5, specialty tier | 25% of the cost | 25% of the cost | no change |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026 | 2027 |
|---|---|---|---|
| Tier 1 | Preferred Generic | $0 | $0 |
| Tier 2 | Generic | 25% of the cost | $6.80 |
| Tier 3 | Preferred Brand | 25% of the cost | 25% of the cost |
| Tier 4 | Non-Preferred Drug | 25% of the cost | 25% of the cost |
| Tier 5 | Specialty Tier | 25% of the cost | 25% of the cost |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 7 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 2 plans have a lower out-of-pocket limit, 4 the same. On the premium, 5 the same, 1 a higher one.
Out-of-pocket limits of the 7 dual-eligible special needs plans
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
The premium and the out-of-pocket limit are the same in all 33 counties: $0 a month and $9,850.
New Mexico
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Which 2026 plans move into it, and what changes for their members?
For 2027 this plan takes in the members of 1 other plan, beside its own 13,127 members. In 2027 it costs $0 a month with a $9,850 limit; each row compares that with the plan its members had in 2026.
| 2026 plan | Members, Sept. 2026 | Members who move | Premium 2026 | Premium change | Limit 2026 | Limit change |
|---|---|---|---|---|---|---|
| Presbyterian Senior Care Extra Health Plan with RxH3204-017 | 936 | 932 | $0 | no change | $6,000 | ▲up $3,850 |
Source: CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11); CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision). Each moving plan's own page lists every line that changes for its members.
Who runs this plan?
- Plan ID
- H3204-013
- Legal name of the contract
- Presbyterian Health Plan
- Sold as
- Presbyterian Health Plan
- Parent company
- Presbyterian Healthcare Services
- Plan type
- HMO D-SNP
- 2026 star rating of the contract
- 3 of 5 overall; health plan 3 of 5, drug plan 2.5 of 5
- Members, September 2026
- 13,127
- Plan website, as filed with CMS
- www.phs.org/Medicare
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Bernalillo, NMWhere most of its members live; premiums and limits side by side
- Every Presbyterian Health Plan plan for 2027Its contracts, counties and plans that end
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.