Providence Medicare Advantage Plans – Part C

Providence Medicare Advantage Plans offer members competitive premiums and cost shares, no-cost fitness facility memberships and over 12,000 in-network providers. Below is a comparison of Providence Medicare Advantage plans available in your area.

Download printer-friendly version – 2017 western Oregon and Clark County, Wash. plan comparison (PDF)

2017 plan comparison – Medical benefits (Part C)

  Providence
Medicare Extra
(HMO)
Providence
Medicare Choice
(HMO-POS) 
Providence
Medicare Prime
(HMO-POS) 
Monthly premium without prescription drug coverage  $109 $45 N/A
Monthly premium with prescription drug coverage 
$162 $88 $0
Note: You must continue to pay your Medicare Part B premium.
  Enroll now Enroll now Enroll now
 
  In-network In-network Out-of-network In-network Out-of-network
Out-of-pocket maximum $3,000 $3,400 $6,700 $5,500 $5,500
Deductible $0 $0 $0
 
Benefits You pay You pay You pay
Gym membership Included at no additional cost
Doctor office visit (PCP) $10Δ
$15Δ
$30Δ
$5Δ
$45Δ
Specialist visit $15Δ
$30Δ
$40 no referralΔ
$40Δ
$40Δ
$60 no referralΔ
$60Δ
Secure video visit $0Δ
$0Δ
No coverage $0Δ  No coverage
Preventive care $0Δ
$0Δ
20%Δ
$0Δ
30%Δ
Lab $0 $0 20% 20% 30%
X-ray 15% 20% 20%
20%
30%
Durable medical equipment 20%
20%
20%
20%°
30%°
Diabetic supplies $0 $0 20% $0°
30%°
Outpatient surgery $150 $250 20% $295 30%
Inpatient hospital
Days 1-5: $250/day
Day 6 and beyond: $0
Days 1-5: $300/day
Day 6 and beyond: $0
20%
Days 1-5: $340/day 
Day 6 and beyond: $0 
30%
Skilled nursing facility
Days 1-20: $0
Days 21-100: $150/day
Days 1-20: $0
Days 21-100: $150/day
20%
Days 1-20: $0 
Days 21-100: $160/day

30%
Home health $0 15% 20% $0
30%
Mental health and chemical dependency counseling $20 $30
20% $40 30%
Therapy: PT, OT, ST $20 $30 20% $40 30%
Medical eye exam $20Δ
$30Δ
$40Δ
$40Δ
$50Δ
WellVision exam $15Δ – one exam per year
$20Δ – one exam per year
$20Δ
Covered up to $45Δ – one exam per year
No coverage No coverage
Basic lenses
Includes glass, plastic, single vision, line bifocal or trifocal, or lenticular prescription lenses
Covered in full – every two years Covered in full – every two years
Single vision: up to $30
Bifocal or progressive: up to $50
Trifocal: up to $65
No coverage
No coverage
Frames Covered up to $100 – every two years Covered up to $100 – every two years Covered up to $70 – every two years No coverage
No coverage
Contact lenses – in lieu of glasses Covered up to $100 – every two years Covered up to $100 – every two years Covered up to $85 – every two years No coverage
No coverage
Worldwide coverage
Urgent care* $40+ $40+ $40+ $40+°
$40+°
Emergency room* $75+ $75+
$75+
$75
$75
Ambulance (air/ground) $250 one way $250 one way $250 one way
$300 one way
$300 one way

* Diagnostic testing copayment may apply.
Δ For office visits, other charges may apply.
+ Copayment waived if admitted within 24 hours for the same condition.
Through VSP providers

See pharmacy coverage – Part D ›

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The provider network may change at any time. You will receive notice when necessary.