at a glance
- Providence offers a variety of HMO plans in Washington and Oregon.
- Providence also offers HMO-POS plans, which provide out-of-network provider choices at a higher cost.
- If you’re eligible for both Medicare and Medicaid, Providence also offers a Special Needs Plan with extra benefits.
- Providence has a history dating back 160 years and provides coverage to more than 650,000 members nationwide.
If you live in certain parts of Oregon or Washington, Providence has a range of Medicare Advantage (Part C) health insurance plans. These plans provide the same coverage as original Medicare (parts A and B), plus some additional benefits to round out your healthcare coverage.
Let’s take a closer look at what Providence Medicare Advantage plans offer, how much they cost, and more.
Providence offers several types of Medicare Advantage plans throughout its service areas. The costs and benefits differ from plan to plan, but we’ll provide a basic overview for each type.
Providence HMO plans
Providence offers a variety of Health Maintenance Organization (HMO) plans. Like all Medicare Advantage plans, these products provide all the same benefits as original Medicare (parts A and B), plus extra services like vision and dental coverage.
In an HMO, you will need to choose your doctors from the plan’s in-network provider directory. You’ll generally see a primary care physician (PCP) for most of your care. From time to time, your PCP may give you a referral to a specialist when needed.
Your plan will not cover medical services you receive from out-of-network healthcare providers unless it’s an emergency.
Providence HMO-POS plans
Providence offers a limited number of HMO Point-of-Service (HMO-POS) plans that allow you to get certain covered services from out-of-network providers. However, your copays will probably be higher when you see these providers. The out-of-network provider must also agree in advance to accept your health insurance plan.
Providence HMO D-SNPs
Providence offers Medicare Advantage HMO Dual Eligible Special Needs Plans (D-SNPs) in Clackamas, Multnomah, and Washington counties in Oregon. These plans are only available to people who are eligible for both Medicare and Medicaid.
Dual Plus HMO D-SNP plans have no premiums, deductibles, or copays. They offer several important benefits such as:
- urgent care services
- no-cost or low-cost prescription drugs
- preventative dental care
- routine eye exams and glasses
Most Providence Medicare Advantage plans offer prescription drug coverage (Medicare Part D). These plans require you to use one of the 34,500 in-network pharmacy locations nationwide. However, there are exceptions when traveling, in emergencies, and for times when your medication is out of stock at your normal pharmacy.
Providence maintains a list of covered medications, called a formulary. The cost and restrictions for the listed drugs can change over time. You will usually be notified about any changes 60 days in advance.
In Washington, Providence covers the following counties:
Providence also covers these Oregon counties:
- Hood River
- Wheeler Yamhill
As you can see, Medicare Advantage plan offerings vary by county, or even city, so enter your specific ZIP code when searching for plans where you live.
Many Providence Medicare Advantage plans offer:
Premiums, deductibles, out-of-pocket limits, copays, and coinsurance rates vary widely from plan to plan. Research these details carefully as you consider your which plan will fit your coverage and financial needs.
Here are some examples of costs you’ll see with Providence Medicare Advantage plans in each of the six coverage areas in 2021:
|Location||Plan||Monthly premium||Health deductible, drug deductible||Out-of-pocket max||PCP copay||Specialist copay|
|Clackamas, Multnomah, Washington, and Yamhill counties in Oregon||Providence Medicare Prime + Rx (HMO)||$0||$0, $150||$5,900||$0||$40|
|Benton and Linn counties in Oregon||Providence Medicare Enrich + Rx (HMO)||$147||$0, $420||$5,000||$15||$40|
|Crook, Deschutes, Hood River, Jefferson, and Wheeler counties in Oregon||Providence Medicare Compass + Rx (HMO-POS)||$55||$0, $0||$5,900 in network, $10,000 in and out of network||$10 in network, $25 out of network||$40 in network, $50 out of network or without referral|
|Columbia, Lane, Marion, Polk counties in Oregon and Clark County in Washington||Providence Medicare Timber + Rx (HMO)||$0||$0, $150||$5,500||$0||$40|
|Snohomish County in Washington||Providence Medicare Summit + Rx (HMO-POS)||$59||$0, $240||$5,500 in network, $10,000 out of network||$5 in network, $25 out of network||$40 in network, $50 out of network or without referral|
|Spokane County in Washington||Providence Medicare Pine + Rx (HMO)||$0||$0, $150||$5,500||$0||$45|
Medicare Advantage (Part C) is a type of health insurance plan offered by private insurance companies. They are required to provide the same coverage as original Medicare (Part A and Part B), plus a variety of extra benefits that vary according to the specific plan.
Because Medicare Advantage plans are private insurance plans, not every company offers coverage in every state. To compare plans in your area, you can use Medicare’s plan finder tool.
Providence offers a variety of Medicare Advantage plans in Oregon and Washington. Most of the plans are HMOs, but Providence does offer a few HMO-POS plans that offer more choices. HMO-POS plans may come with higher copays and more cost-sharing for members.
Providence also offers an HMO D-SNP program for people who are eligible for both Medicare and Medicaid. Most of the plans include prescription drug coverage.
Costs, benefits, and provider networks vary from plan to plan, so you may want to use Medicare’s plan finder to explore each plan and find the ones that might work for you.