Home > ProCare Advantage (HMO I-SNP) Medicare Advantage Plan

2021 - ProCare Advantage (HMO I-SNP)

Get all the benefits and services covered under Original Medicare Parts A & B, plus Part D prescription drug coverage, and added health benefits and services.

HealthCare Benefit †	Plan Details
On-site Nurse Practitioner + customized care team	Regular, personalized, on-site visits Coordinates your clinical care Direct member access
Primary care physician (PCP) visits + preventive care	$0 copay for in-room PCP visits at your community 20% coinsurance for PCP office visits
Dental	$200 allowance for preventive dental services
Vision	$0 copay* for routine eye exam $100 for eyewear every year
Podiatry	$0 copay* for 4 routine foot care visits every year
Prescription drugs	Prescription drug coverage Pharmacy coordination and monitoring
Skilled Nursing	No prior hospital stay required
Non-emergency Transportation	24 one-way trips for healthcare services every year

$22.50*

Monthly Premium

People with limited incomes may qualify for Extra Help. Contact your plan representative to learn more.

†This list of benefits is in addition to Original Medicare. See Summary of Benefits for a complete list of benefits. All benefits listed above will begin on January 1, 2020. *$0 copay for these extra benefits, up to the annual limit.

Get all the benefits and services covered under Original Medicare Parts A & B, Plus Part D prescription drug coverage and added health benefits and services.

HealthCare Benefit †

Primary care physician (PCP) visits + preventive care

Regular, personalized, on-site visits
Coordinates your clinical care
Direct member access

On-site Nurse Practitioner + customized care team

$0 copay*

$0 copay for in-room PCP visits at your community
20% coinsurance for PCP office visits

Dental

$175 allowance for preventive dental services

Vision

$0 copay* for routine eye exam
$100 for eyewear every year

Podiatry

$0 copay* for 4 routine foot care visits every year

Prescription drugs

Prescription drug coverage
Pharmacy coordination and monitoring

Skilled nursing

No prior hospital stay required

Non-emergency Transportation

24 one-way trips for healthcare services every year

$28.20*

Monthly Premium

People with limited incomes may qualify for Extra Help. Contact your plan representative to learn more.

†This list of benefits is in addition to Original Medicare. See Summary of Benefits for a complete list of benefits. All benefits listed above will begin on January 1, 2020.*$0 copay for these extra benefits, up to the annual limit.

ProCare Advantage is offered in the following participating communities:
(The participating communities are the same for plan year 2020 and 2021)

Dallas County

The Villa at Mountain View

2918 Duncanville Road,

Dallas, TX 75211

Windsor Gardens

2535 West Pleasant Run,

Lancaster, TX 75146

Crestview Court

224 W Pleasant Run Road,

Cedar Hill, TX 75104

The Manor at Seagoville

2416 Elizabeth Lane,

Seagoville, TX 75159

The Madison on Marsh

2245 Marsh Lane,

Carrollton, TX 75006

Palomino Place

3160 Gus Thomasson Road,

Mesquite, TX 75150

Harris County

Ashford Gardens

7210 Northline Drive,

Houston, TX 77076

The Broadmoor at Creekside Park

5665 Creekside Forest Drive,

The Woodlands, TX 77389

Solera at West Houston

2101 Greenhouse Road,

Houston, TX 77084

Jefferson County

Magnolia Manor

4400 Gulf Street,

Groves, TX 77619

Bonne Vie

8595 Medical Center Blvd.,

Port Arthur, TX 77619

Orange County

Oakwood Manor

225 South Main Street,

Vidor, TX 77662

Hardin County

Silsbee Convalescent Center

1105 West Highway 418,

Sulsbee, TX 77656

Brazoria County

The Colonnades at Reflection Bay

12001 Shadow Creek Park,

Pearland, TX 77584

Laurel Court

3830 Mustang Road,

Alvin, TX 77511

Denton County

Prairie Estates

1350 Main Street,

Frisco, TX 75033

Hollymead

4101 Long Prairie Road,

Flower Mound, TX 75028

Colin County

Carrara

4501 Tradition Trail,

Plano, TX 75093

The Belmont at Twin Creeks

999 Rantree Circle,

Allen, TX 75013

San Remo

3550 Shiloh Road,

Richardson, TX 75082

Bexar County

Sorrento

2739 Babcock Road,

San Antonio, TX 78229

Windemere

11106 Christus Hill,

San Antonio, TX 78251

Coronado at Stone Oak

19638 Stone Oak Parkway,

San Antonio, TX 78258

Tarrant County

The Harrison at Heritage

4600 Heritage Trace Parkway,

Ft. Worth, TX 76244

The Carlyle at Stonbridge Park

170 Stonebridge Lane,

Southlake, TX 76092

Fort Bend County

The Crescent

11353 Sugar Park Lane,

Sugar Land, TX 77478

Fort Bend HealthCare Center

3010 Bamore Road,

Rosenberg, TX 77471

What do I pay?

The amount you pay depends on the payment stage you are in when you fill your prescription. Your payment stage changes during the calendar year based on your total drug costs.

STAGE 1

Yearly deductible: $445 for all Part D prescription drugs

STAGE 2

Initial coverage

Once the yearly deductible is met, you pay 25% coinsurance for all drugs covered by this plan until your total yearly drug costs reach $4,130.

STAGE 3

Coverage Gap

After your total drug costs (including what our plan has paid and what you have paid) reach $4,130, you will pay no more than 25% coinsurance for generic drugs or 25% coinsurance for brand name drugs, for any drug tier during the coverage gap.

STAGE 4

Catastrophic coverage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $6,550, you pay the greater of:

5% coinsurance, or
$3.70 copayment for generic (including brand drugs treated as generic) and a $9.20 copayment for all other drugs.

If you take many medications for more than one chronic health condition you may be eligible to participate in the
Medication Therapy Management (MTM) program offered by the Centers for Medicare and Medicaid Services. Speak to a licensed ProCare plan representative for more details.

Cost-sharing may differ based on point-of-service (retail, Long Term Care (LTC)), home infusion, whether the pharmacy is in our standard network, or whether the prescription is a short-term (30-day supply) or long-term (90-day supply).