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El Paso Health Total (HMO)

Texas Medicare Advantage Plan (2026 Plan)

Monthly Premium

Your Cost
$0
by El Paso Health Medicare Advantage

Additional Coverage

HearingVisionDental

Overall Government Star Rating

(coming soon)

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Plan Overview

Plan Name
El Paso Health Total (HMO)
Insurance Carrier
El Paso Health Medicare Advantage
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

El Paso Health Total (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Texas and offered by the health insurance company El Paso Health Medicare Advantage. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$4,000
Primary doctor visit
$0 copay
Specialist visit
$25 copay
ER visit
No Data
Ambulance
$300 copay

El Paso Health Total (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $4,000 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for El Paso Health Total (HMO) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

El Paso Health Total (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. El Paso Health Total (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. El Paso Health Total (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Not covered
Telehealth
Limited coverage

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$4,000 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
http://ephmedicare.com
Plan Link
http://ephmedicare.com

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $25 copay
Out-of-network: $25 copay

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $90 copay
Out-of-network: $90 copay
Lab services
In-network: $0-$60 copay
Out-of-network: $0-$60 copay
Diagnostic radiology services (like MRI)
In-network: $165-$320 copay
Out-of-network: $165-$320 copay
Outpatient x-rays
In-network: $0-$125 copay
Out-of-network: $0-$125 copay
Emergency care
In-network: No Data
Out-of-network: No Data
Urgent care
In-network: No Data
Out-of-network: No Data

Hospital Services

Inpatient hospital coverage
In-network: No Data
Out-of-network: No Data
Outpatient hospital coverage
In-network: $0-$150 copay
Out-of-network: $0-$150 copay

Skilled nursing facility

Skilled nursing facility
In-network: No Data
Out-of-network: No Data

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: $300 copay
Out-of-network: $300 copay

Therapy services

Occupational therapy visit
In-network: $25 copay
Out-of-network: $25 copay
Physical therapy & speech & language therapy visit
In-network: $25-$30 copay
Out-of-network: $25-$30 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $25 copay
Out-of-network: $25 copay
Outpatient individual therapy with a psychiatrist
In-network: $25 copay
Out-of-network: $25 copay
Outpatient group therapy visit
In-network: $25 copay
Out-of-network: $25 copay
Outpatient individual therapy visit
In-network: $25 copay
Out-of-network: $25 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Diabetes supplies
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$0.00 copay$0 copay
Generic$0.00 copay$0 copay
Preferred Brand$35.00 copay$0 copay
Non-Preferred Drug30% coinsurance$0 copay
Specialty Tier28% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Other Part B drugs
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - prescription
In-network: $525-$1000 copay
Out-of-network: $525-$1000 copay
Hearing aids - over the counter
Not covered

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
Not covered
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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