Medicare Advantage · C-SNP · HMOPOS · 2027
ProCare Advantage - Kidney Care (HMO-POS C-SNP)
No referral needed to see a specialist
At a glance: $0 monthly premium and $0 primary care visits.
Eligibility required for this C-SNP. The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Chronic kidney disease. See who can enroll
- Monthly premium
- $0
- Part B premium separate
- Yearly limit
- $9,850
- Most you’d pay for in-network care
- Dental
- $2,000/yr
- Comprehensive dental allowance
- Doctor visits
- $0
- Primary care · specialists 20%
Check this plan for you
Add your doctors and prescriptions to see how they work with this plan.
- DentalComprehensive dental allowance
- $2,000/yr
- VisionEyewear allowance
- $175/yr
- Fitness$0 fitness benefit
- Included
- Transportation100 one-way trips/year
- Included
- MealsMeal benefit
- Included
This is a supplemental benefit with plan-specific limits. See plan documents for details.
Talk to a licensed agent
Eligibility required for this C-SNP
The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Chronic kidney disease. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.
Talk with a licensed advisor
A licensed agent can review this plan and other plans in your area that fit your needs.
TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST
Who can enroll
Eligibility for this Special Needs Plan
Eligibility required for this C-SNP
The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Chronic kidney disease. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.
Extra benefits for members who qualify
- Food and produce benefit
- Non-medical transportation benefit
- General supports for living
These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.
Costs and copays
Deductible, yearly limit, visits and drug tiers
- Drug deductiblePer year
- $0
- Yearly limitIn-network care, not counting drugs
- $9,850
- Yearly limit, in and out of networkCombined, not counting drugs
- $9,850
- Primary doctorPer visit
- $0
- SpecialistPer visit · no referral needed
- 20%
- Outpatient surgeryPer procedure
- 20%
- Emergency roomPer visit
- $115
- Urgent carePer visit
- 20% (max $40/visit)
- Tier 1 · Preferred Generic30-day supply at a retail pharmacy
- 5%
- Tier 2 · Generic30-day supply at a retail pharmacy
- 25%
- Tier 3 · Preferred Brand30-day supply at a retail pharmacy
- 25%
- Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy
- 25%
- Tier 5 · Specialty30-day supply at a retail pharmacy
- 33%
Our take
Where this plan shines, and what to know
Where this plan shines
- This plan has a $0 monthly premium.
- See your primary doctor for $0.
- No separate drug deductible.
- Some out-of-network care is covered (HMO-POS).
Things to know before you enroll
- This plan’s out-of-pocket maximum is above the national median.
- Limited coverage while traveling outside the plan’s service area.
Similar plans
Other Medicare Advantage plans offered in Texas
Browse the full 2027 Chronic Condition Special Needs Plan directory. This plan is offered in Texas. Plan availability can vary by county.
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Common questions
6 answers about this plan
What does ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS) cover?
ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS) is a Chronic Condition Special Needs Plan, a Medicare Advantage plan for people whose qualifying condition the plan verifies, including end stage renal disease. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 5 formulary tiers. Published supplemental benefits include dental ($2,000/yr comprehensive dental allowance), vision ($175/yr eyewear allowance), fitness ($0 fitness benefit), and transportation (100 one-way trips/year). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.
Learn about Medicare AdvantageHow much does ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS) cost in 2027?
The published 2027 monthly plan premium for ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS) is $0. Any Medicare premiums you owe are separate from the listed plan premium. The listed Part D deductible is $0. The in-network medical out-of-pocket maximum is $9,850; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits 20%. These figures are plan data, not a personal yearly-cost estimate.
Understand Medicare drug-cost limitsCan I use my current doctors with ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS)?
CMS lists ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS) as a HMOPOS plan. The plan record says specialist referrals are not required. The record also identifies point-of-service flexibility, but exact out-of-network rules can vary. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.
Check your doctorsWhat chronic conditions qualify for ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS)?
ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS) is listed in the current plan record as a C-SNP. The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Chronic kidney disease. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.
Learn about Special Needs PlansHow does ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS) coordinate care for my chronic condition?
ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS) is identified in the current plan record as a Chronic Condition Special Needs Plan for qualifying conditions that include Chronic kidney disease. The record also lists dental ($2,000/yr comprehensive dental allowance), vision ($175/yr eyewear allowance), and fitness ($0 fitness benefit). The data on this page does not describe a personal care plan or promise a specific care coordinator. Review the Evidence of Coverage and ask the plan how its model of care, provider communication, and medication support apply to your verified condition.
When can I enroll in ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS)?
ProCare Advantage - Kidney Care (HMO-POS C-SNP) (HMOPOS) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a C-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.
Review Medicare enrollment periodsPlan documents
Summary of Benefits and Evidence of Coverage
- Summary of Benefits (PDF)Download the plan's official Summary of Benefits document
- Evidence of Coverage (PDF)Complete plan details and rules
- Check Your DoctorsSee if your doctors accept this plan
- Documentos en españolLlame a The Pocket Protector al 1-866-764-3312 (TTY: 711) para recibir ayuda con documentos en español
Talk to a licensed agent
Eligibility required for this C-SNP
The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Chronic kidney disease. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.
Talk with a licensed advisor
A licensed agent can review this plan and other plans in your area that fit your needs.
TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST
