2017 plan comparison

This is only a brief comparison of benefits. Medicare coverage rules apply to the benefits listed below, for instance, you must continue to pay your Medicare Part B premium.

Medical benefits

 

​Providence Align Group Plan + Rx (HMO) Providence Medicare Flex Group Plan + Rx (HMO-POS)​
 
​In-plan ​In-plan ​Out-of-plan
Out-of-pocket maximum ​$1,500
​ ​$3,000 combined in- and out-of-network
Deductible  $0  $0
 
Benefits ​You pay ​You pay
​Free gym membership
Included at no additional cost​ ​ ​
​Doctor office visit (PCP) ​$15 ​$20 ​$30^
​Specialist visit ​$20 ​$25
​$35^
Secure video visit $0 $0  No coverage 
Preventive care $0  $0  $0^ 
​Lab ​$0 ​$0 ​20%
​X-ray ​10% ​10% ​20%
Durable medical equipment ​20% ​20% ​20%
Diabetic supplies ​$0 ​$0 20%
Outpatient surgery ​$75 ​$150 ​20%
​Inpatient hospital ​$100 per day
$500 maximum per admit
​$125
$500 maximum per admit
​20%
​Skilled nursing facility ​Days 1-100: $0 ​Days 1-20: $0
Days 21-100: $50/day
​20%
​Home health ​$0 ​10% ​20%
​Mental health and chemical dependency counseling ​$20 ​$25 ​$35
Therapy: PT, OT, ST ​$20 ​$25 ​$35^
Chiropractic (Medicare covered only) ​$20 ​$20
​$35
​Podiatry (Medicare covered only) ​$20 $25
​$35
​Cardiac and pulmonary rehabilitation (Medicare covered only) ​$20 ​$25 ​$35
​Part B medications ​20% ​20% ​20%
Medical eye exam  $20 $25  $35^
WellVision eye exam° $15  $20  $20^
Covered up to $45 
Basic lenses° – includes glass, plastic, single vision, lined bifocal or trifocal, or lenticular prescription glasses
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* ​$25+ ​$25+
​$25+
​Emergency room* ​$50+
​​$65+
​$65+
​Ambulance (air/ground) ​$50 ​$50 ​$50

*Diagnostic imaging may apply.
^For office visits, other charges may apply.
+Copayment is waived if admitted within 24 hours for the same condition.
°Through VSP providers

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 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.

H9047_2017RCGA01
Website is current as of 09/01/2016