2018 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.
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_2018RCGAPHA11
Website is current as of 11/27/2017