Providence Health Plan has been providing health insurance since 1984 when a health maintenance organization was formed by the Providence Portland Medical Center and the St. Vincent Medical Center. Several mergers and name changes later, the Providence Health Plan that exists today was formed. They provide health insurance to more than 326,000 members in Oregon and southwest Washington. They offer a variety of plans for companies, those on Medicare or Medicaid, individuals and families. They currently have more than 50,000 Medicare members and 35,000 Medicaid members.

 

Providence offers two Medicare options to their members, Providence Medicare Extra and Providence Medicare Choice. Both of these plans are offered with the choice of adding an optional prescription drug plan. Below is a brief description of the plan choices. These do not cover every aspect of the plans, and you should call our specialists to learn more about the plans and for help finding the right plan for you.

 

The Providence Medicare Extra (HMO) provides access to quality health care within the provider network. The monthly premium for these plans range from $92 to $117, depending on if the prescription plan being included or not. The copay for doctor or specialist visits on either of these plans is $15. The outpatient surgery fee is $100. Routine and Medical Eye Exams are $15, and the out-of-pocket maximum is $2,500.

 

The Providence Medicare Choice (HMOPOS) plan allows you to access quality services within or outside of the provider network. The monthly premium for these plans range from $32 to $58, depending on if the prescription plan being included or not. The copay for doctor or specialist visits to in-network doctors is $20, for out-of-network doctors is $30. The outpatient surgery fee is $150 for in-network and 20% for out-of-network. Routine and Medical Eye Exams are $20 for in-network and $30 for out-of-network. The out-of-pocket maximum for either of these plans is $3,400.

 

The prescription drug coverage benefits are offered in three phases. Phase 1 is the initial coverage. You pay no deductible, only $6 or $9 for generic drugs, and $45 for brand name drugs. Specialty drugs are charged at 33%. When you reach the paid total of $2,830 you enter phase 2. Phase 2 is the coverage gap. You pay all costs until you reach the out-of-pocket limit of $4,550. At phase 3 the benefits restart but at a different level. You still have no deductible but now only pay $2.50 for generic drugs, $6.30 or 5% whichever is greater for any brand name and specialty drugs.

 

If you are interested in getting a Medicare Supplemental Plan from Providence Health Plan, please contact the Medicare experts at eAmeriFamily Insurance.  They are industry veterans and will guide you through the process of getting the right Medicare, Medicare Advantage, MediGap, or Medicare Supplement Plan for you.