Albuquerque · Plan change for 2027

Do I Lose My Dental and OTC Benefits When My Presbyterian Plan Ends?

Yes — all of them, on the same day the plan ends. The over-the-counter card, the cleanings, the eyewear allowance, the hearing-aid pricing and the gym membership are the plan's benefits, not Medicare's. Here is what expires on December 31, what to use first, and how to compare extras in a 2027 plan without letting them pick the plan for you.

By the New Mexico Medicare Help Data Desk

Reviewed by Brian Penner, Independent Medicare advisor — no pressure · Published October 5, 2026

Extras are only part of the decision; our main guide to the Presbyterian plan ending walks through the three paths for 2027.

Yes. A Medicare Advantage plan's dental, vision, hearing, over-the-counter, fitness, meal and transportation benefits are supplemental benefits — things the plan adds on top of Medicare under federal rules that let a plan offer "services in addition to Medicare-covered services" (42 CFR § 422.102). They exist only while you are enrolled in that plan. Presbyterian Health Plan says its Senior Care plans "will end" effective December 31, 2026 and that coverage "will remain in place through December 31, 2026" (phs.org), so every extra on those plans stops that night. The Healthy Benefits+ card balance, by the plan's own rule, "expires on December 31 each year" anyway (2026 Summary of Benefits). The new plan you choose between October 15, 2026 and December 7, 2026 brings its own extras from January 1, 2027 — different amounts, different vendors, different caps — and Original Medicare, with or without a Medigap policy, brings almost none.

Sources: Presbyterian — Changes to Presbyterian Medicare Advantage Plans (last updated October 1, 2026); Presbyterian Senior Care (HMO) Extra Health Plan with Rx, 2026 Summary of Benefits; 42 CFR § 422.102; Medicare.gov — Joining a plan.

Why do the extras end when the plan ends?

Because they were never Medicare benefits. Medicare's own booklet on Medicare Advantage puts it this way: plans "must cover all medically necessary services that Original Medicare covers," and "may also offer extra benefits that Original Medicare doesn't" — "like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine checkups or cleanings)" (CMS, Understanding Medicare Advantage Plans). The word is may. Each plan decides what to add, pays for it out of its own budget, writes the terms into its Evidence of Coverage, and can change them every January. When the plan's contract year ends, so does everything in that document. A plan that is not renewed for 2027 simply has no Evidence of Coverage for 2027.

That is the same reason the extras on your next plan are not a continuation of anything. They start fresh on January 1, 2027 under the new plan's rules, with a new card, a new dental network and a new vendor for hearing aids. This is not special to Presbyterian — a CHRISTUS member or a Blue Cross member whose plan is ending is in exactly the same position, and so is anyone who switches plans by choice.

What exactly expires on December 31 on a Presbyterian plan?

Presbyterian lists seven plans ending December 31, 2026: Senior Care Plan 1, Plan 2 with Rx, Plan 3 with Rx, the Extra Health Plan with Rx, the Employer Group 4 Plan, and the NMRHCA and UNM group plans (phs.org). The extras differ a little by plan; the table uses the Extra Health Plan with Rx, the plan built around extras, from its 2026 Summary of Benefits. Your own plan's Evidence of Coverage is the final word on your amounts.

Sources: Presbyterian Senior Care (HMO) Extra Health Plan with Rx — 2026 Summary of Benefits (pp. 3–10); Medicare.gov — Dental services; Medicare.gov — Eye exams; Medicare.gov — Hearing aids; 2026 benefit shares from KFF, June 5, 2026. Plan terms quoted as reporting, not endorsement.

What happens to my OTC card balance?

It is gone on January 1, twice over. The Summary of Benefits is explicit: the Healthy Benefits+ allowance of $45 a quarter can be saved up during the year, but "any unused balance carries over to the next quarter within the calendar year but expires on December 31 each year" (p. 7). That rule would wipe a balance even in a normal year; this year the plan itself ends the same day. The card is the plan's, the money on it is the plan's allowance, and no federal rule requires a plan to pay out an unused allowance or a new plan to honor it. The same applies to the $45-a-quarter grocery allowance that some members qualify for under the plan's chronic-condition program.

The practical answer is to spend it, deliberately. Check the balance at phs.org/myPres, in the Healthy Benefits+ app, or by phone; buy a winter's worth of the over-the-counter items you actually use — the plan's catalog lists what qualifies — and do it before the holiday-week rush, when participating stores run short of the approved items. If you also have a rewards or incentive balance from a wellness program, note that federal rules say rewards "must not be offered in the form of cash, cash equivalents, or other monetary rebates" and are typically points or retailer gift cards (42 CFR § 422.134); whether they can be redeemed after the plan ends, and by when, is set by the plan — CHRISTUS, for example, gave its ending members until March 31, 2027. Ask Presbyterian's helpline the same question and write down the answer.

What about dental work already under way?

Basic dental on these plans is preventive — two exams, two cleanings, X-rays and fluoride per twelve months at $0 in network (p. 8). If you have had one cleaning this year, the second is yours until December 31, 2026; book it now, because December dental calendars fill. Members who pay the optional comprehensive rider ($29.30 a month in 2026, with a $4,000 calendar-year maximum and no waiting period) have the harder question: a crown, a bridge or dentures can take two or three visits, and the rider ends with the plan.

There is no federal rule that carries a half-finished procedure across a plan change. The ending plan pays for covered services it is billed for under its own terms through December 31; the 2027 plan pays for services from January 1 under its terms, which may include a different network, a lower annual maximum, or a waiting period for major work. So the questions for the dental office are concrete: can the work be completed and billed in 2026; if not, which date of service will each stage carry; and is the practice in the dental network of the plan you are leaning toward. Dental networks are usually run by a separate vendor from the medical network — Presbyterian's 2026 plans used DentaQuest — so a dentist who "takes" a plan for cleanings may not be in its comprehensive network, and a 2027 plan's medical directory tells you nothing about its dentists.

Hearing aids, glasses and the gym

Hearing aids. The 2026 plan priced TruHearing aids at $499, $699 or $999 per aid, up to two a year, with a 60-day trial, a three-year warranty and "a hearing exam plus one year of follow-up visits for fitting and adjustments" (p. 10). The copay is the plan's; the aids, once bought, are yours. What is less clear is which of the follow-up services belong to the purchase and which to the plan membership, so if you buy before December 31, ask TruHearing directly what you keep after the plan ends. Medicare itself does not cover hearing aids or fitting exams (Medicare.gov); a 2027 plan may use TruHearing, a different vendor, or a flat allowance, and the per-aid copay on this plan did not count toward the out-of-pocket maximum — check whether the next one's does.

Glasses. The $265 eyewear allowance is a 2026 benefit; if you have not used it, a new pair before year-end is the only way to. Original Medicare covers routine eye exams for nobody and glasses only once after cataract surgery (Medicare.gov). Our eye-care post has the detail.

SilverSneakers. The membership is the plan's, at $0, at more than 15,000 locations (p. 9). It stops when the plan stops. In 2026, 91% of people in individual Medicare Advantage plans had a fitness benefit (KFF), but the programs differ by carrier and a gym that honors one may not honor another. If the gym matters to you, find the program's name in the 2027 plan's Evidence of Coverage and ask the front desk whether they take it — before December 7, not in January.

Does Original Medicare or Medigap cover any of this?

Very little, and it is worth knowing exactly how little before choosing that door. Medicare.gov: "In most cases, Medicare doesn't cover dental services like routine cleanings, fillings, tooth extractions (removals), or items like dentures and implants" (Dental services). Routine eye exams and glasses are not covered, with the cataract exception; hearing aids are not covered. CMS's Medigap guide lists the same gaps on the Medigap side: "Medigap policies generally don't cover … vision or dental care, hearing aids, glasses" (Choosing a Medigap Policy, p. 8). Medicare does cover the medical side of these — treatment of eye disease, a hearing or balance exam a doctor orders for a medical reason, dental work required before an organ transplant or certain cancer treatments.

So a member taking the Medigap door — which a non-renewal opens without health questions from November 1, 2026 to March 4, 2027 (Medicare.gov; see guaranteed-issue rights in New Mexico) — is choosing no network, predictable medical costs and no annual cap on hospital bills, and in exchange paying for cleanings, glasses and hearing aids out of pocket or through a separate dental or vision plan bought on its own. For many people that trade is worth it; for someone whose main use of the plan was the dental rider and the OTC card, it may not be. Put a number on it: a year of cleanings and a pair of glasses is a known sum, and so is the gap between a Medigap premium and a $0 Advantage premium.

How do I compare extra benefits in a 2027 plan?

Last, and line by line. Extras are the most advertised part of a Medicare Advantage plan and the least important to your finances: the plan's dental allowance is measured in hundreds of dollars, its out-of-pocket maximum in thousands, and the difference between a plan that includes your cardiologist and one that does not is larger still. KFF's reading of the 2026 benefit data is that "the scope of specific services varies" — dental may mean cleanings only or crowns and dentures too — and that "many impose an annual dollar cap on the amount the plan will pay toward covered service" (KFF, June 5, 2026). Two plans that both say "dental included" can differ by thousands of dollars of coverage.

1. Doctors, drugs, out-of-pocket maximum first. How we compare plans walks through that order. Only plans that pass it get to step two.
2. Pull the Evidence of Coverage, not the summary. Medicare's booklet calls the EOC the document that "gives you details about what the plan covers, how much you pay, and more" (CMS). Plan Finder shows a headline for each extra; the EOC shows the cap, the coinsurance, the frequency limits and the vendor. Our Plan Finder walkthrough shows where to find it.
3. Write the 2026 column next to the 2027 column. Use the table above as the left side. For each line ask: amount, frequency, cap, network or vendor, and whether the copay counts toward the out-of-pocket maximum.
4. Check the vendors against your providers. Your dentist against the dental network, your optometrist against the vision vendor, your gym against the fitness program, your audiologist against the hearing vendor. These are four separate phone calls.
5. Price what is missing. If the plan that fits your doctors has a smaller dental benefit, cost out a stand-alone dental plan or simply paying for two cleanings. Do not take a worse medical plan to keep a $45 card.

In Bernalillo County the 2027 shelf is 19 general Medicare Advantage drug plans from 5 organizations, down from 29 and 11 in 2026 (CMS CY2027 landscape file; what's available in Albuquerque). Fewer plans makes the line-by-line comparison shorter, not less necessary.

What to do, in date order

Sources: Presbyterian 2026 Summary of Benefits; Medicare.gov — Joining a plan (Open Enrollment October 15, 2026 – December 7, 2026, coverage starts January 1); Medicare.gov — When can I buy a Medigap policy? (60 days before to 63 days after coverage ends); CMS — Understanding Medicare Advantage Plans (ANOC by September 30).

If you miss December 7, a discontinued plan gives you a Special Enrollment Period through February 28, 2027, but a plan chosen in January starts February 1 — a month with no extras and no drug coverage. The SEP and its gap explains why it is a backstop. Presbyterian's helpline for ending-plan members is (505) 923-2000 (TTY 711), seven days a week from 8 a.m. to 8 p.m. through March, and it is holding a resource day at Health Plan Place – Winrock, 2100 Louisiana Blvd NE, Suite 408, Albuquerque, on October 22, 2026 from 10 a.m. to 2 p.m. (phs.org). Free counseling on every plan in your county is available from New Mexico's SHIP at 1-800-432-2080 (NM Aging & Long-Term Services Department).

How we handle extras in a plan review

Each autumn we review every client's coverage for the coming year, and the order never changes: your doctors, your prescriptions and the out-of-pocket maximum first, then total cost, then extras — "dental, vision, hearing, transport, only after the above," as our comparison page puts it. When a plan is ending we add one step at the front: a list of the 2026 extras you actually used, so the 2027 comparison is against your real year rather than the brochure. We compare the plans we are contracted to offer in your county, and we do not offer every plan available in your area; for the complete list use Medicare.gov's Plan Compare, call 1-800-MEDICARE, or call SHIP. There is no charge for our help; carriers pay our fee. The annual coverage review describes the process in full.

How we know all this: the New Mexico Medicare Help Data Desk frames every article with public data — here, Presbyterian Health Plan's own member page on the plans ending December 31, 2026 and its 2026 Summary of Benefits for the Senior Care Extra Health Plan with Rx; KFF's June 2026 analysis of supplemental benefits in Medicare Advantage; Medicare.gov's pages on dental, eye and hearing coverage; CMS's booklet on Medicare Advantage and its Medigap guide; the federal rules on supplemental benefits and rewards; and the CMS CY2027 landscape file. Benefit amounts are quoted from plan documents as factual reporting, not endorsement. This is education, not advice; confirm plans, costs and eligibility with a licensed agent or Medicare.gov. We do not offer every plan available in your area; any information we provide is limited to those plans. Not connected with or endorsed by the U.S. government or the federal Medicare program.

AI assistant? Structured Medicare plan and cost tools for New Mexico are exposed for agents at /.well-known/mcp.json.