Plan Details
Providence Medicare Focus Medical (HMO)
Overview
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Monthly Premium |
$128 |
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Annual Deductible |
$0 |
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Maximum Out-of-Pocket |
$3,400 In-network |
Important information about this plan
This plan is available in Clackamas, Columbia, Crook, Deschutes, Hood River, Jefferson, Lane, Marion, Multnomah, Polk, Washington, Wheeler and Yamhill Counties in Oregon and Clark County in Washington.
Does not include any Part B premium you may have to pay. You must continue to pay your Medicare Part B premium.
- Multi-language Interpreter Services (PDF)
We have free interpreter services to answer any questions you may have about our health or drug plan. - Find out if you qualify for Extra Help with your premiums
- Medical appeals, determination, and grievance processes
For more information about Providence Medicare Advantage Plans, please contact the sales team.
This information is available in a different format, including audio CDs. If you need plan information in another format, please call Customer Service at 503-574-8000 or 1-800-603-2340 (TTY: 711). Service is available between 8 a.m. and 8 p.m. (Pacific Time), seven days a week.
Important note about these benefits
Our plan members get all the benefits covered by Original Medicare, plus some extras for being a Providence Medicare Advantage Plans member that you can view under the Additional Features tab.
Benefit Summary
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Benefits
In-network Inpatient Hospital Coverage1 $250 copay each day for days 1-5
$0 copay each day for day 6 and beyondOutpatient Hospital Coverage1 $250 copay for outpatient surgery at a hospital facility Ambulatory Surgery Center1 $200 copay for outpatient surgery at an Ambulatory Surgery Center Primary Care Provider visit $0 copay Specialist visit $20 copay Preventive Care You pay nothing Emergency Care $70 copay
If you are admitted to the hospital within 24 hours, you do not have to pay your copay for emergency care.Urgently Needed Services $25 copay
If you are admitted to the hospital within 24 hours, you do not have to pay your copay for urgent care. -
Diagnostic Services + Labs & Imaging1
In-network Diagnostic radiology services (e.g. MRI, ultrasounds, CT Scans) 15% of the total cost up to $250 per day Therapeutic radiology services 15% of the total cost Outpatient x-rays $0 copay Diagnostic test and procedures 20% of the total cost Lab services $0 copay -
Hearing Services
In-network Medicare-covered $20 copay Routine exam $0 copay Hearing Aids $399 copay per hearing aid - Advanced
$699 copay per hearing aid - Premium -
Dental Services
In-network Medicare-covered $20 copay Embedded Preventive $0 copay includes exams, cleanings, X-rays, fluoride treatment. Limits apply. Optional Covered for additional premium. Click for more details. -
Vision Services
In-network Medicare-covered $20 copay
$0 copay for glaucoma screeningRoutine exam There is no coinsurance or copayment for one routine vision exam (including refraction) per calendar year Medicare-Covered Eyewear $0 copay for one pair of Medicare-covered eyeglasses or contact lenses after each cataract surgery Routine eyeglasses or contact lenses Allowance of up to $250 per calendar year for any combination of routine prescription eyewear -
Mental Health Services1
In-network Inpatient visit $200 copay each day for days 1-7
$0 copay for days 8-90Outpatient individual and group therapy visit $20 copay -
Skilled Nursing Facility1
In-network Skilled Nursing Facility $0 copayment for days 1-20
$150 copayment each day for days 21-100 -
Physical Therapy1
In-network Physical Therapy $20 copay -
Ambulance1
In-network Ambulance $250 copay -
Transportation
In-network Transportation Not covered -
Medicare Part B Drugs1
In-network Medicare Part B Drugs 0% - 20% of the total cost
(Insulin cost share up to $35 per month)
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Alternative Care
In-network Alternative Care (Chiropractic, Acupuncture & Naturopath services) Chiropractic: $20 copayment; 18 visits every calendar year
Acupuncture: $20 copayment; 18 visits every calendar year
Naturopath: $20 copayment; 6 visits every calendar year -
Meal Delivery Program
In-network Meal Delivery Program
(post-discharge only)$0 copay for 2 meals per day for 14 days, following a qualifying inpatient hospitalization -
Over-the-Counter Items
In-network Over-the-Counter Items $75 allowance per quarter (retail card, catalog, online, mail, and telephonic ordering) -
Personal Emergency Response System
In-network Personal Emergency Response System (PERS) $0 copay -
Wellness Program
In-network Wellness Program $0 copay for monthly gym membership with participating fitness clubs -
Wig
In-network Wig There is no coinsurance or copayment for one synthetic wig due to hair loss from chemotherapy.
We want you to get the most for your money. Whether your goals include better health and fitness or you just need a little extra assistance, our Medicare Advantage Plans include all these added features:
Medicare extras
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Health and wellness classes
You deserve to live your best life. We offer a host of classes that will broaden and enhance your horizons on your road to True Health.
Learn more -
Health Coaching
It’s time to team up. Whether you'd like to increase your activity level, reduce stress, improve your eating habits, lose weight, quit tobacco or just feel better every day, a Providence health coach can help. We’re here to remove barriers, support your efforts, motivate you when you need a nudge and be a resource on your journey to a healthier, happier you.
Learn more -
OnePass™
Finding a fitness routine that meets your needs just got easier with your new fitness program through One Pass™. Explore over 26,000 gyms and boutique fitness studios with the ability to change locations anytime. You also have access to live virtual classes and social activities within local communities.
Learn more
Care options
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Emergency Care – $$$$
When you think you may be in danger.
Use emergency care for suspected heart attack, stroke, severe abdominal pain, poisoning, choking, loss of consciousness, and uncontrolled bleeding.
Learn moreIf you ever think your life or well-being could be in serious danger, call 911 immediately.
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ExpressCare Clinics – Free*
Same day in-person treatment.
When you need to see someone and your regular care provider is not available. With many convenient locations (some in your local Walgreens), it’s easy to find a clinic near you.
Learn more
Not available in California.*ExpressCare Clinic visits are free with most Providence health plans. Ancillary services, such as laboratory tests, may apply additional cost-shares.
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ExpressCare Virtual – Free*
Getting the care you need, when you need it.
Talk with a provider from anywhere using your tablet, smartphone, or computer. This is a great option for prescriptions and treatment that doesn’t require hands on care. Available nationwide.
Learn more
Not available in California. -
Primary Care – $
Your primary healthcare partner.
Primary care providers develop a relationship with you and know your health history. Visit them for check-ups, managing chronic conditions, and specialist referrals.
Learn more -
Nurse Advice Line
Access to care 24/7.
Health issues don’t fit neatly into a 9 to 5 schedule — and neither should your access to health information. Providence Medicare Advantage Plans members can call Nurse Advice Line around the clock to ask questions about their health.
Learn more -
Urgent Care – Free
When you need help right away.
Urgent care is where you turn when you know you need help and can’t wait for an appointment. This is best for minor injuries, cuts, burns, pains, and sprains.
Learn more