2022 CHRISTUS Health Plan Guardian (HMO)
CHRISTUS Health Plan Guardian (HMO) H1189-007 is a 2022 Medicare Advantage Plan or Part-C by CHRISTUS Health Plan Generations available to residents in New Mexico. This plan does not provide additional prescription drug (Part-D) coverage. The CHRISTUS Health Plan Guardian (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,900 out-of-pocket. This can be a extremely nice safety net.
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CHRISTUS Health Plan Guardian (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.
CHRISTUS Health Plan Generations works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for CHRISTUS Health Plan Guardian (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from CHRISTUS Health Plan Generations and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from CHRISTUS Health Plan Generations except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.
2022 CHRISTUS Health Plan Generations Medicare Advantage Plan Costs
| Name: | CHRISTUS Health Plan Guardian (HMO) |
|---|---|
| Plan ID: | H1189-007 |
| Provider: | CHRISTUS Health Plan Generations |
| Year: | 2022 |
| Type: | Local HMO * |
| Monthly Premium C+D: | $0 |
| Part C Premium: | |
| MOOP: | $4,900 |
| Similar Plan: | H1189-008 |
| New Plan: | 2023 H1189-008 |
CMS Star Ratings for CHRISTUS Health Plan Guardian (HMO) H1189
| 2021 Overall Rating | ||
|---|---|---|
| Part C Summary Rating | ||
| Part-D Summary Rating | ||
| Staying Healthy: Screenings, Tests, Vaccines | ||
| Managing Chronic (Long Term) Conditions | ||
| Member Experience with Health Plan | ||
| Complaints and Changes in Plans Performance | ||
| Health Plan Customer Service | ||
| Drug Plan Customer Service | ||
| Complaints and Changes in the Drug Plan | ||
| Member Experience with the Drug Plan | ||
| Drug Safety and Accuracy of Drug Pricing |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancer Screening | ||
| Annual Flu Vaccine | ||
| Monitoring Physical Activity |
Managing Chronic And Long Term Care for Older Adults
| Total Rating | ||
|---|---|---|
| SNP Care Management | ||
| Medication Review | ||
| Functional Status Assessment | ||
| Osteoporosis Management | ||
| Diabetes Care - Eye Exam | ||
| Diabetes Care - Kidney Disease | ||
| Diabetes Care - Blood Sugar | ||
| Rheumatoid Arthritis | ||
| Reducing Risk of Falling | ||
| Improving Bladder Control | ||
| Medication Reconciliation | ||
| Statin Therapy |
Member Experience with Health Plan
| Total Experience Rating | ||
|---|---|---|
| Getting Needed Care | ||
| Getting Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints and Changes in CHRISTUS Health Plan Guardian (HMO) Plans Performance
| Total Rating | ||
|---|---|---|
| Complaints about Health Plan | ||
| Members Leaving the Plan | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for CHRISTUS Health Plan Guardian (HMO)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center, TTY, Foreign Language |
CHRISTUS Health Plan Guardian (HMO) Drug Plan Customer Service Ratings
| Total Rating | ||
|---|---|---|
| Call Center, TTY, Foreign Language |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating | ||
|---|---|---|
| Complaints about the Drug Plan | ||
| Members Choosing to Leave the Plan | ||
| Drug Plan Quality Improvement |
Member Experience with the Drug Plan
| Total Rating | ||
|---|---|---|
| Rating of Drug Plan | ||
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating | ||
|---|---|---|
| MPF Price Accuracy | ||
| Drug Adherence for Diabetes Medications | ||
| Drug Adherence for Hypertension (RAS antagonists) | ||
| Drug Adherence for Cholesterol (Statins) | ||
| MTM Program Completion Rate for CMR | ||
| Statin with Diabetes |
Coverage Area for CHRISTUS Health Plan Guardian (HMO)
(Click county to compare all available Advantage plans)
| State: |
New Mexico |
|---|---|
| County: |
Los Alamos Rio Arriba San Miguel Santa Fe |
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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.
Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.