- 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.
If you live in certain parts of Oregon or Washington, Providence has a range of Medicare Advantage 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.
Providence offers Medicare Advantage plans in Washington and Oregon. In Washington, Providence covers Clark, Snohomish, and Spokane counties. In Oregon, Providence covers Clackamas, Columbia, Lane, Marion, Multnomah, Polk, Washington, and Yamhill counties.
Providence offers several types of Medicare Advantage plans in its six geographical service areas. The costs and benefits differ from plan to plan, but we’ll provide an overview of the basics for each type.
Providence offers a variety of Health Maintenance Organization (HMO) plans across its two-state service area. 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. Some plans include coverage of alternative healthcare services such as chiropractic and acupuncture services, but annual limits may apply.
In an HMO, your plan does not cover medical services you receive from out-of-network healthcare providers unless it’s an emergency. You will need to choose your doctor from the 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.
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. But your copay will probably be higher with these plans. The out-of-network provider also has to agree in advance to treat you.
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:
Most Providence Medicare Advantage plans offer prescription drug coverage (Medicare Part D). Most plans require you to use one of the 42,800 in-network pharmacy locations but there are exceptions for travel, emergencies, and times when your normal pharmacy is out of stock.
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 changes 60 days in advance.
Many Providence Medicare Advantage plans offer:
- preventive medical and dental care
- free fitness center memberships
- express care virtual (on-demand telehealth services)
- routine vision and hearing care
- optional dental plans
Coverage, premiums, deductibles, out-of-pocket max limits, copays, and coinsurance rates vary widely from plan to plan. Research these details as you consider your different plan options. Here are some examples of costs from Providence’s list of 2020 Medicare Advantage plans:
|Plan||Monthly premium with drug coverage||Health plan annual deductible||Drug plan deductible||Out-of-pocket max (in-network)||PCP copay & coinsurance||Specialist copays & coinsurance|
|Prime +RX (service area 1)||$0||$0||$270 (waived for generics)||$5,900||$0||$40|
|Medicare Extra 002 + RX (service area 2)||$173||$0||$0||$3,400||$0||$20|
|Compass + RX||$99||$0||$270 (waived for generics)||$6,700 in network, $10,000 out of network||$10 in network, $25 out of network||$40 in network, $50 out of network|
|Summit RX||$59||$0||$240 (waived for generics)||$5,500 in network, $10,000 out of network||$5||40% of cost|
|Focus HMO (medical only, no RX area)||$128||$0||—||$3,400||$0||$20|
Medicare Advantage 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.
Medicare Part D plans cover prescription drugs. Like Medicare Advantage plans, they are also offered by private insurance companies.
Each insurer lists the prescription drugs its plans cover in a formulary. The formulary describes any limits or restrictions that apply to the drug and ranks drugs into tiers according to their copay costs.
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.
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