2021 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
|
Days 1-4: $125
Days 5 and beyond: $0
|
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
|
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.
H9047_PHAGRAM15
Website is current as of 9/10/2020