2022 Providence Medicare Select Medical (HMO-POS)

Providence Medicare Select Medical (HMO-POS) H9047-035 is a 2022 Medicare Advantage Plan or Part-C by Providence Medicare Advantage Plans available to residents in Oregon and Washington. This plan does not provide additional prescription drug (Part-D) coverage. The Providence Medicare Select Medical (HMO-POS) has a monthly premium of $51.00 and has an in-network maximum out-of-pocket limit of $4,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,500 out-of-pocket. This can be a extremely nice safety net.

Providence Medicare Select Medical (HMO-POS) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

Providence Medicare Advantage Plans works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Providence Medicare Select Medical (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Providence Medicare Advantage Plans and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Providence Medicare Advantage Plans except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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Sat 8am-8pm EST

2022 Providence Medicare Advantage Plans Medicare Advantage Plan Costs

2021 Providence Medicare Select Medical (HMO-POS) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance
Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	20% coinsurance
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Lab services	$0 copay
Lab services	30% coinsurance (Out-of-Network)
Outpatient x-rays	30% coinsurance (Out-of-Network)
Outpatient x-rays	$15 copay

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Doctor Visits

Primary	$15 copay per visit
Primary	$25 copay per visit (Out-of-Network)
Specialist	$30 copay per visit
Specialist	$50 copay per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$50 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	30% coinsurance (Out-of-Network)
Foot exams and treatment	$30 copay
Routine foot care	Not covered

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Ground Ambulance

$50-250 copay
$50-250 copay (Out-of-Network)

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Hearing

Fitting/evaluation	Not covered
Hearing aids	$699-999 copay
Hearing exam	$30 copay
Hearing exam	30% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

30% per stay (Out-of-Network)
$300 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 91 and beyond

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Medical Equipment/Supplies

Diabetes supplies	30% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	30% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	30% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$275 per day for days 1 through 6 $0 per day for days 7 through 90
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit	$30 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$30 copay
Outpatient individual therapy visit	$30 copay
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$30 copay

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MOOP

$10,000 In and Out-of-network $4,500 In-network $10,000 Out-of-network

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Option

No

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Optional supplemental benefits

Yes

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Outpatient Hospital Coverage

$250 copay per visit
30% coinsurance per visit (Out-of-Network)

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Package #1

Deductible	$150.00
Monthly Premium	$33.70

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Package #2

Deductible	$150.00
Monthly Premium	$46.50

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Preventive Care

$0 copay
30% coinsurance (Out-of-Network)

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Preventive Dental

Cleaning	Covered under office visit
Dental x-ray(s)	Covered under office visit
Fluoride treatment	Not covered
Office visit	$15.00
Oral exam	Covered under office visit

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Rehabilitation Services

Occupational therapy visit	30% coinsurance (Out-of-Network)
Occupational therapy visit	$30 copay
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$30 copay

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Skilled Nursing Facility

30% per stay (Out-of-Network)
$0 per day for days 1 through 20 $160 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	$0 copay (Out-of-Network)
Upgrades	$0 copay
Upgrades	$0 copay (Out-of-Network)

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Providence Medicare Select Medical (HMO-POS) H9047

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Providence Medicare Select Medical (HMO-POS) Plans Performance

Health Plan Customer Service Rating for Providence Medicare Select Medical (HMO-POS)

Providence Medicare Select Medical (HMO-POS) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Providence Medicare Select Medical (HMO-POS)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.