Eligibility and Coverage

For Medicare Advantage

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Eligibility and Coverage

During the Annual Enrollment Period

As you approach the Annual Enrollment period, it's essential to assess any changes in your life that might impact your Medicare Advantage coverage.

During a Qualifying Life Event

Qualifying life events, such as moving to a new area or turning 65 can influence your healthcare needs and coverage options. You don't have to wait for an annual enrollment period to get coverage if you have a qualifying life event.

Review Your Plan to Ensure it Still Meets Your Needs

If your health changes, you may need additional coverage beyond Medicare A and B. Moving to a new area can alter available plans, and if your plan is discontinued or costs rise, reviewing new options may be necessary. Changes in provider networks, satisfaction with your plan, or employment status can also impact your coverage choices.

Coverage Areas

  • New Mexico: Bernalillo, Los Alamos, Otero, Rio Arriba, San Miguel, Sandoval, Santa Fe, and Taos

  • Central Texas: Caldwell, Comal, and Guadalupe

  • Northeast Texas: Bowie, Camp, Cass, Cherokee, Franklin, Gregg, Harrison, Henderson, Hopkins, Marion, Morris, Panola, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, and Wood

  • South Texas: Bee, Jim Wells, Kleberg, Nueces, Refugio, and San Patricio

  • Southeast Texas: Hardin, Jasper, Jefferson, Newton, Orange, and Tyler

Requirements

To be eligible for CHRISTUS Health Medicare Complete, Medicare Plus or Medicare Guardian plans, you must meet these requirements:

  • Are a United States citizen or are lawfully present in the United States
  • Must physically live in the coverage areas within New Mexico or Texas and meet all terms and conditions for coverage in this policy.
  • Must be eligible for Medicare.
  • Have both Medicare Part A Part B
  • Must pay your deductible, copay or coinsurance at the time you receive covered services. CHRISTUS Health Plan will reimburse the provider balance due for covered services. Your summary of benefits can be found in the forms and documents section with more information on cost sharing.

2025 Coverage Area Maps

Benefits

We’ve Got You Covered From A to D

CHRISTUS Health Medicare Complete, Medicare Plus or Medicare Guardian plan are Medicare Advantage plan options. Medicare Advantage plans offer all-inclusive benefits, from Part A and Part B, to Part D (drug coverage).

*Note: In order to be eligible to receive Part C and D benefits, you have to have already qualified for parts A and B through Medicare. With a network of providers and facilities close to home, it’s everything you need in one convenient place.

***CHRISTUS Health Medicare Complete and Medicare Plus plans provide Part A, Part B, Part C and Part D coverage, while Medicare Guardian Plans cover Part A, Part B and Part C coverage.***


What Does Each Part Cover

Part A: Hospital Insurance Benefits (i.e. 24/7 Nurse Hotline at 1-844-581-3174)

Part B: Medical Insurance Benefits (i.e. your primary care provider and specialists)

Part C: Medicare Advantage Plans (Parts A and B with added benefits like annual eye exams, preventive dental cleaning, other various programs to keep you healthy)

Part D: Prescription Drug Coverage (Medication Therapy Management Program)


Disclaimer

CHRISTUS Health Advantage is an HMO plan with a Medicare contract. Enrollment in CHRISTUS Health Advantage depends on contract renewal.

This information is not a complete description of benefits.

Open seven days a week, 8:00 a.m. to 8:00 p.m., local time, from October 1 – March 31, and Monday – Friday, 8:00 a.m. to 8:00 p.m., local time, from April 1 – September 30.

Call 1-844-282-3026/TTY 711 for more information. A voice response system is available after hours. Other providers are also available in our network.

CHRISTUS Health Advantage (HMO) Contract #H1189.

H1189_WEB25MM3012_M | Last Updated 2/5/25