2020 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
|
| Prescription eyeglasses (lenses, frames, upgrades) |
Covered up to $100 – every two years |
Covered up to $100 – every two years |
Covered up to $100 – 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 $100 – 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.
+Copayment is waived if admitted within 24 hours for the same condition.
Providence Medicare Advantage Plans is an HMO, HMO‐POS and HMO SNP with Medicare and Oregon Health Plan contracts. Enrollment in Providence Medicare Advantage Plans depends on contract renewal.
H9047_GRAM07_2020
Website is current as of 10/11/2019