2020 Medicare Advantage Plan Comparison - Providence ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2020 Medicare
Advantage Plan
Comparison
Providence Medicare Timber + Rx (HMO)
Providence Medicare Bridge 2 + Rx (HMO)
Providence Medicare Choice + Rx 002 (HMO-POS)
Providence Medicare Extra + Rx 002 (HMO)
Service area:
Columbia, Lane, Marion, Polk counties in Oregon, and Clark County in Washington
H9047_2020PHA16_C MDC-165PWhy choose Providence? Medicare choices can be confusing. So we’re here to make it easier. Providence Medicare Advantage Plans support you every step of the way. You’re covered, whenever and wherever you need care. Plus, you'll get extra features and convenient tools to help you live well. Variety of plans and options We designed our plans with your needs and budget in mind with different plan types and cost sharing options (deductibles, coinsurance and copayments), there's a plan for everyone. Broad network With access to thousands of network providers, you'll find quality care when you need it. Care for you and the community We care about the total well-being of each person we serve. That’s why we donate vital health care services that support the issues and challenges of our local communities. Experience and innovation We're part of Providence St. Joseph Health so you benefit from more than 160 years of health care experience and innovation. With our broad resources, you'll get modern conveniences, like telemedicine, and integrated systems that make it simpler for you to get the very best care possible. 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. 02 ProvidenceHealthAssurance.com H9047_2020PHA27_M
2020 Providence Medicare
Service Area Map
+ Timber + Rx (HMO)
+ Bridge 2 + Rx (HMO)
+ Choice + Rx 002 (HMO-POS)
+ Extra + Rx 002 (HMO)
Additional plans are available in the area.
Visit ProvidenceHealthAssurance.com
for more information.
Columbia
Clark
Polk Marion
Lane
H9047_2020PHA27_M ProvidenceHealthAssurance.com 03Benefits and services
beyond Original Medicare
Put all the perks of Providence Medicare Advantage Plans to work for you. From
achieving better health and fitness to accessing coaching and support, our plans
bring these extras and more:
Annual routine eye exam Providence Express Care
offered on all plans and an allowance Virtual and Express Care
for prescription glasses, frames and/or no-cost, on-demand provider visits from
contacts on some plans. your computer or smartphone, or visit one
of our Express Care clinics for same-day
Annual routine hearing exam care in many locations.
and hearing aid benefit
provides you with high-quality Health coaching
hearing aids and local professional can help you lose weight,
care at a fraction of the cost. increase your physical activity or
just feel better when you join
No-cost fitness the 92 percent of Providence health
center membership coaching participants who’ve
made a lifestyle improvement.
so you can work out your way, or
even work out at home using
two home-fitness kits per year. myProvidence
so you can access a summary
24/7 nurse advice of your benefits, view claims,
so you can connect with pay your premium and get
registered nurses day or night prescription drug information.
with no cost to you.
Savings and assistance
Optional home assessments with My Advocate®
with licensed, board-certified nurses. which connects members
with a variety of government
and community programs.
Health coaching visits limited to 12 per calendar year. 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.
04 ProvidenceHealthAssurance.com H9047_2020PHA49_MProvidence Medicare Advantage Plans – Part C
Providence Medicare Providence Medicare
Timber + Rx (HMO) Bridge 2 + Rx (HMO)
Monthly premium
with prescription $0 $40
drug coverage
In-network In-network
Medical deductible $0 $0
Out-of-pocket maximum $5,500 $4,900
Benefits You pay You pay
Doctor office visit (PCP) $0 $0
Specialist visit $40 $35
Preventive care $0 $0
Days 1-4: $450/day Days 1-6: $325/day
Inpatient hospital
Day 5 and beyond: $0/day Day 7 and beyond: $0/day
Days 1-20: $0 Days 1-20: $0
Skilled nursing facility
Days 21-100: $172/day Days 21-100: $160/day
Outpatient surgery $450 $375
Diabetic supplies $0 – 20% $0 – 20%
Lab $0 $0
X-ray $15 $10
Outpatient diagnostic tests
$0 $0
and procedures
$20-$40; $20-$35;
Alternative care
$500 annual maximum $500 annual maximum
Therapy: PT, OT, ST $40 $35
Durable medical
20% 20%
equipment
Chiropractic $20 $20
Home health $0 $0
Secure video visits $0 $0
No-cost fitness center
$0 $0
membership included
Preventive dental $15 $15
Worldwide coverage Worldwide coverage
Urgent care $50 $50
Emergency room $90 $90
Ambulance (air/ground) $50 – $250 one way $50 – $250 one way
See your Evidence of Coverage for more information. Out-of-network/non-contracted providers are under no
obligation to treat Providence Medicare Advantage Plans members, except in emergency situations. Please
call our customer service number or see your Evidence of Coverage for more information, including the cost
sharing that applies to out-of-network services.
05 ProvidenceHealthAssurance.com H9047_2020PHA60_MProvidence Medicare Advantage Plans – Part C
Providence Medicare Providence Medicare
Choice + Rx 002 (HMO-POS) Extra + Rx 002 (HMO)
$88 $173
In-network Out-of-network In-network
$0 $0 $0
$4,500 $10,000 combined $3,400
You pay You pay
$15 $25 $0
$30 $50 $20
$0 30% $0
Days 1-6: $300/day Days 1-5: $250/day
30%
Day 7 and beyond: $0/day Day 6 and beyond: $0/day
Days 1-20: $0 Days 1-20: $0
30%
Days 21-100:$160/day Days 21-100: $150/day
$250 30% $150
$0 – 20% 30% $0 – 20%
$0 30% $0
$15 30% $0
$0 30% $0
No coverage No coverage No coverage
$30 30% $20
20% 30% 20%
$20 30% $20
$0 30% $0
$0 No coverage $0
$0 No coverage $0
No coverage No coverage $15
Worldwide coverage Worldwide coverage
$50 $50 $50
$90 $90 $70
$50 – $250 one way $50 – $250 one way $50 – $250 one way
Other charges and limits may apply.
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_2020PHA60_M ProvidenceHealthAssurance.com 06Pharmacy coverage – Part D
Providence Providence Providence Medicare Providence
Medicare Timber Medicare Bridge Choice + Rx 002 Medicare Extra
+ Rx (HMO) 2 + Rx (HMO) (HMO-POS) + Rx 002 (HMO)
$270 (waived on $200 (waived on $240 (waived on $0 (waived on
Annual deductible††
generic tiers) generic tiers) generic tiers) generic tiers)
30-day 90-day 30-day 90-day 30-day 90-day 30-day 90-day
Preferred generic $0 $0 $0 $0 $4 $8 $0 $0
Generic $10 $10 $10 $10 $13 $31.20 $10 $10
Preferred brand $47 $141 $47 $141 $47 $112.80 $45 $90
Non-preferred drugs $100 $300 $100 $300 $100 $240 $90 $180
Specialty drugs 28% N/A 29% N/A 28% N/A 33% N/A
Deductible is waived on all generic tiers (Tiers 1 and 2).
††
Copays listed are for Preferred Network pharmacies only; other pharmacy copays may cost more.
For Extra + Rx 002 (HMO), your Phase 2 coverage gap cost share for preferred generic drugs at a Preferred
Network pharmacy or mail-order pharmacy will be $0. All other cost shares will be 25%.
Initial coverage Coverage gap Catastrophic coverage
Phase 1 Phase 2 Phase 3
When the total paid by you You pay only 25% of the costs of You pay whichever of these is
and the plan reaches $4,020, brand-name drugs and 25% of the larger: either 5% coinsurance
Phase 2 begins. costs of generic drugs. You stay in for the costs of the drug or
this stage until your out-of-pocket $3.60 copay for generic drugs;
costs reach $6,350. After that, $8.95 copay for brand-name or
Phase 3 begins. specialty drugs.
Vision coverage – included at no extra charge
Providence Providence Providence Medicare Providence
Medicare Timber Medicare Bridge Choice + Rx 002 Medicare Extra
+ Rx (HMO) 2 + Rx (HMO) (HMO-POS) + Rx 002 (HMO)
Up to $75 Up to $75
Routine eye exams Up to $75 allowance Up to $75 allowance
allowance allowance
Prescription
$100 allowance $150 allowance $220 allowance $215 allowance
eyeglasses
per year per year per year per year
or contact lenses
You are responsible for any cost above the allowance for routine eye exams, prescription eyeglasses or
contact lenses.
Hearing coverage – included at no extra charge
Providence Providence Providence Medicare Providence
Medicare Timber Medicare Bridge Choice + Rx 002 Medicare Extra
+ Rx (HMO) 2 + Rx (HMO) (HMO-POS) + Rx 002 (HMO)
$0
Routine hearing
$0 $0 copay out-of-network: $0
exam (one per year)
not covered
Hearing aids $699 – $999
$499 – $799 per $399 – $699 per per hearing aid $499 – $799
(up to two hearing
hearing aid hearing aid out-of-network: per hearing aid
aids per year) not covered
You must see a TruHearing provider. Other charges and limits may apply.
07 ProvidenceHealthAssurance.com H9047_2020PHA60_M2020 Optional Supplemental Dental Benefits
Plans that include
Bridge 2 + Rx, Extra + Rx 002, Timber + Rx
Wrap options:
Basic Wrap Enhanced Wrap
Monthly premium $29.40 $42.20
In-network Out-of-network In-network Out-of-network
Plan benefits member member member member
responsibility responsibility* responsibility responsibility*
Office visit copay No copay No copay
Annual deductible 1
$50 $150 $50 $150
Annual maximum $1,000 $1,500
Waiting periods None None
Provider network Any licensed dentist2 Any licensed dentist2
Out-of-network reimbursement Maximum allowable charge Maximum allowable charge
Diagnostic and Preventive Services
Oral examinations3 0% 20% 0% 20%
Bitewing X-rays 4
0% 20% 0% 20%
Panoramic and other
0% 20% 0% 20%
diagnostic X-rays5
Comprehensive Dental Services
Basic fillings and simple
50% 60% 50% 60%
extractions
Dentures6 50% 60% 50% 60%
Crowns and bridges7 50% 60% 50% 60%
Oral surgery Not covered 50% 60%
Endodontics (root canals) Not covered 50% 60%
Periodontics Not covered 50% 60%
*Important notes: Out-of-network dentists may charge more than the amount allowed by Providence Medicare
Advantage Plans. If this happens, they may send members a "balance bill" for the difference between their
charged amount and the amount paid by the plan.
1
Deductibles are waived for diagnostic and preventive services
2
Seeking care from a participating in-network dentist will reduce out-of-pocket costs and prevent a balance bill
3
Oral examinations – limited to one per calendar year
4
Bitewing or Periapical X-rays – limited to one bitewing and two periapical per calendar year
5
Panoramic or other diagnostic X-rays – limited to one per five years
6
$250 lifetime denture benefit
7
Crown/bridge max. (Basic) – $100 per tooth per year; crown/bridge max. (Enhanced) – $500 per year
08 ProvidenceHealthAssurance.com H9047_2020PHA51_M2020 Optional Supplemental Dental Benefits
Plans that include
Choice + Rx 002
Basic or Enhanced option:
Basic Enhanced
Monthly premium $33.70 $46.50
In-network Out-of-network In-network Out-of-network
Plan benefits member member member member
responsibility responsibility* responsibility responsibility*
Office visit copay No copay No copay
Annual deductible 1
$50 $150 $50 $150
Annual maximum $1,000 $1,500
Waiting periods None None
Provider network Any licensed dentist2 Any licensed dentist2
Out-of-network reimbursement Maximum allowable charge Maximum allowable charge
Diagnostic and Preventive Services
Oral examinations3 0% 20% 0% 20%
Semiannual teeth cleaning 4
0% 20% 0% 20%
Bitewing X-rays5 0% 20% 0% 20%
Full, panoramic and other
0% 20% 0% 20%
diagnostic X-rays6
Comprehensive Dental Services
Basic fillings and simple
50% 60% 50% 60%
extractions
Dentures7 50% 60% 50% 60%
Crowns and bridges8 50% 60% 50% 60%
Oral surgery Not covered 50% 60%
Endodontics (root canals) Not covered 50% 60%
Periodontics Not covered 50% 60%
*Important notes: Out-of-network dentists may charge more than the amount allowed by Providence Medicare
Advantage Plans. If this happens, they may send members a "balance bill" for the difference between their
charged amount and the amount paid by the plan.
1
Deductibles are waived for diagnostic and preventive services
2
Seeking care from a participating in-network dentist will reduce out-of-pocket costs and prevent a balance bill
3
Oral examinations – limited to two per calendar year
4
Teeth cleanings (prophylaxis: cleaning and polishing teeth) – limited to two per calendar year
5
Bitewing or Periapical X-rays – limited to two per calendar year
6
Full, panoramic or other diagnostic X-rays – limited to one per five years
7
$250 lifetime denture benefit
8
Crown/bridge max. (Basic) – $100 per tooth per year; crown/bridge max. (Enhanced) – $500 per year
H9047_2020PHA51_M ProvidenceHealthAssurance.com 09Our Mission As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable. Our Values Compassion | Dignity | Justice | Excellence | Integrity Call us for information, to enroll, or to make a personal appointment at 866-948-4985 8 a.m. to 8 p.m. (Pacific Time), seven days a week (Oct. 1 – Dec. 7); Monday – Friday (Dec. 8 – Sept. 30) Enroll online at ProvidenceHealthAssurance.com Providence Health & Services, a not-for-profit health system, is an equal opportunity organization in the provision of health care services and employment opportunities. © 2019 Providence Health Plan. All rights reserved. H9047_2020PHA16_C MDC-165P
You can also read
