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) 
Monthly premium without prescription drug coverage  $109 $45
Monthly premium with prescription drug coverage 
$162 $88
Note: You must continue to pay your Medicare Part B premium.
  Enroll now Enroll now
 
  In-Plan In-Plan Out-of-Plan
Out-of-pocket maximum $3,000 $3,400 $6,700
combined
Deductible $0 $0
 
Benefits You pay You pay
Gym membership Included at no additional cost
Doctor office visit (PCP) $10Δ
$15Δ
$30Δ
Specialist visit $15Δ
$30Δ
$40 no referralΔ
$40Δ
Secure video visit $0Δ
$0Δ
No coverage
Preventive care $0Δ
$0Δ
20%Δ
Lab $0 $0 20%
X-ray 15% 20% 20%
Durable medical equipment 20%
20%
20%
Diabetic supplies $0 $0 20%
Outpatient surgery $150 $250 20%
Inpatient hospital
Days 1-5: $250/day
Day 6 and beyond: $0
Days 1-5: $300/day
Day 6 and beyond: $0
20%
Skilled nursing facility
Days 1-20: $0
Days 21-100: $150/day
Days 1-20: $0
Days 21-100: $150/day
20%
Home health $0 15% 20%
Mental health and chemical dependency counseling $20 $30
20%
Therapy: PT, OT, ST $20 $30 20%
Medical eye exam $20Δ
$30Δ
$40Δ
WellVision eye exam $15Δ – one exam per year
$20Δ – one exam per year
$20Δ
Covered up to $45 – one exam per year
Basic lenses
Includes glass, plastic, single vision, lined 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
Frames Covered up to $100 – every two years Covered up to $100 – every two years Covered up to $70 – every two years
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
Worldwide coverage
Urgent care* $40+ $40+ $40+
Emergency room* $75+ $75+
$75+
Ambulance (air/ground) $250 one way $250 one way $250 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.