2017 Medical (Part C) and prescription drug (Part D) benefits

Providence Medicare Dual Plus (HMO SNP)

Providence Medicare Dual Plus (HMO SNP) is designed to meet the needs of individuals who are currently enrolled in Medicare and have full benefit Medicaid coverage. 

This plan is available to residents of Clackamas, Multnomah and Washington counties.

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Medical Benefit You Pay* 
Monthly premium $0
Annual deductible $0 
Annual wellness visit  $0
Primary care physician visits $0
Specialist visits $0
Preventive care $0
Lab tests $0
X-rays $0
Diabetic supplies $0
Outpatient surgery and hospital services $0
Inpatient hospital $0
Ambulance services $0
Urgent care $0
Emergency room $0
 Prescription Benefit You Pay 
Generic drugs $0, $1.20, $3.30
All other prescription drugs $0, $3.70, $8.25

Additional Benefits for Members of Providence Medicare Dual Plus (HMO SNP)
Routine vision care   
    Routine eye exam
$0 for one exam/year
    Glasses and contact lenses $0 – covered in full once a year
    Frames You get $100 each year for frames or contact lenses
24-hour nurse advice $0
Gym membership or home fitness kits $0
Health education – includes weight management, stress management, pain education, childbirth classes, smoking cessation and nutrition classes You get a $500 annual allowance for health education classes at Providence facilities

*For certain members, the Oregon Health Plan (Medicaid) may only pay cost-sharing amounts for services that the Oregon Health Plan would normally cover. Please contact the Oregon Health Plan or your Oregon Health Plan Coordinated Care Organization for more information. Providence Medicare Dual Plus (HMO SNP) members who are enrolled with Health Share/Providence for the Oregon Health Plan will not have out-of-pocket costs for any Medicare-covered medical services. Prescription drug cost-sharing amounts still apply. 

Providence Medicare Dual Plus (HMO SNP) is available to you if you have Medicare Part A and B, you have full Oregon Health Plan (OHP) Medicaid benefits, and you live in Clackamas, Multnomah or Washington County. You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual enrollees who are eligible for Providence Medicare Dual Plus (HMO SNP). Premiums, co-pays, co-insurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. 

Providence Medicare Advantage Plans is an HMO, HMO-POS, and HMO SNP plan with a Medicare and Oregon Health Plan contract. Enrollment in Providence Medicare Advantage Plans depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information.