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ProCare Advantage - Kidney Care (HMO-POS C-SNP)

Texas Chronic Condition Special Needs C-SNP Plan (2026 Plan)

Monthly Premium

Your Cost
$5
by ProCare Advantage

Additional Coverage

VisionDental

Overall Government Star Rating

(coming soon)

Ready to Enroll Online?

Plan Overview

Plan Name
ProCare Advantage - Kidney Care (HMO-POS C-SNP)
Insurance Carrier
ProCare Advantage
Plan Type
Chronic Condition Special Needs Plan (C-SNP)
Network Type
HMO

ProCare Advantage - Kidney Care (HMO-POS C-SNP) is a Chronic Condition Special Needs Plan (C-SNP), which is available in Texas and offered by the health insurance company ProCare 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
$5
Annual Deductible
Coming soon
Max Out-of-Pocket
$9,250
Primary doctor visit
$0 copay
Specialist visit
20% coinsurance
ER visit
$90 copay
Ambulance
20% coinsurance

ProCare Advantage - Kidney Care (HMO-POS C-SNP) has a monthly premium cost of $5 per month, with an annual deductible of Coming soon and a maximum out of pocket cost sharing of $9,250 In and Out-of-network $9,250 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 ProCare Advantage - Kidney Care (HMO-POS C-SNP) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
No
Hearing

ProCare Advantage - Kidney Care (HMO-POS C-SNP) 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. ProCare Advantage - Kidney Care (HMO-POS C-SNP) includes coverage for vision, dental.

Medicare Advantage health plans can offer even more additional benefits. ProCare Advantage - Kidney Care (HMO-POS C-SNP) 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
Not covered
Annual physical exams
Not covered
Telehealth
Limited coverage

Plan Benefits and Coverage Details

Monthly Premium
$5
Health Portion of Premium
$0
Drug Portion of Premium
$5
Health Plan Deductible
Coming soon
Health Plan Max Out-of-Pocket
$9,250 In and Out-of-network
$9,250 In-network
Nationwide Coverage included
No
Hearing Coverage included
No
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
http://www.procareadvantageplan.com
Plan Link
http://www.procareadvantageplan.com

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: $0 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient x-rays
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Emergency care
$90 copay
Urgent care
20% coinsurance

Hospital Services

Inpatient hospital coverage
In-network:
  Tier 1
  $0 per day for days 1-60
  $419 per day for days 61-90
  $838 per day for days 91-150
Out-of-network:
  $ per stay
Outpatient hospital coverage
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Skilled nursing facility

Skilled nursing facility
Out-of-network:
  $ per stay

Preventive services

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

Ambulance

Ground ambulance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Therapy services

Occupational therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: 20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

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: $0 copay
Out-of-network: $0 copay

Prescription Drug Benefits

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

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25% coinsurance

Brand-name drugs :
25% coinsurance


Generic drugs :
0% coinsurance

Brand-name drugs :
0% coinsurance

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

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
Not covered
Fitting/evaluation
Not covered
Hearing aids - prescription
Not covered
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
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

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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