A non-government entity
Providence Medicare Focus Medical (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Providence Medicare Focus Medical (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Providence Medicare Focus Medical (HMO) in 2026, please refer to our full plan details page.
Providence Medicare Focus Medical (HMO) is a HMO plan offered by Providence St Joseph Health available for enrollment in 2025 to people living in Portland Metro, Lane, Hood River, Clark WA. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Providence Medicare Focus Medical (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Providence Medicare Focus Medical (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Providence Medicare Focus Medical (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by Providence Medicare Focus Medical (HMO).
Additional Benefits
The Providence Medicare Focus Medical (HMO) plan offers comprehensive coverage with no copay and no coinsurance for primary care doctor visits, preventive services, and home health care. Specialist visits, dental care, and routine vision and hearing exams are highly accessible, requiring only a $20 copay and no coinsurance. For emergency situations, the plan features a $130 emergency room copay that is waived upon admission, alongside a $250 daily copay for the first five days of an inpatient hospital stay. Diagnostic tests, medical imaging, and durable medical equipment are covered with no copay and a 15% to 20% coinsurance. Members also benefit from extra perks with no copay and no coinsurance, including a $250 annual eyewear allowance and a $100 over-the-counter item allowance every six months. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits under the Providence Medicare Focus Medical (HMO) are covered with no coinsurance, requiring a $250 daily copay for days 1 to 5 of an acute stay and a $200 daily copay for days 1 to 7 of a psychiatric stay. Prior authorization is required, and while unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Providence Medicare Focus Medical (HMO) with no coinsurance, featuring a $250 copay for outpatient hospital visits, a $70 copay per stay for observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $20 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Providence Medicare Focus Medical (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Providence Medicare Focus Medical (HMO), with ground and air ambulance services requiring prior authorization and a copay of $50.00 to $275.00 with no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered under the Providence Medicare Focus Medical (HMO) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $25 for urgent care, $130 for emergency care, and $275 for emergency transportation.
Primary Care See details
Providence Medicare Focus Medical (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy services, and mental health care require a $20 copay and no coinsurance. Telehealth and opioid treatment services feature a $0 to $20 copay and no coinsurance, though podiatry is not covered and chiropractic services are only partially covered with routine chiropractic care excluded.
Preventive Services See details
Preventive Services are covered by the Providence Medicare Focus Medical (HMO) plan with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings. Additional preventive services are partially covered with no copay and no coinsurance, but sub-services like health education, weight management, in-home safety assessments, and alternative therapies are not covered.
Hearing Services See details
Providence Medicare Focus Medical (HMO) covers hearing services, including one annual routine hearing exam for a $20 copay and no coinsurance, as well as unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay between $499 and $999 for up to two devices per year, while OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Providence Medicare Focus Medical (HMO) covers one routine eye exam annually with a $20 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $250 yearly limit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Providence Medicare Focus Medical (HMO), with preventive care and select comprehensive services requiring no copay and no coinsurance, while Medicare-covered dental services require a $20 copay and no coinsurance. Implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Providence Medicare Focus Medical (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs like chemotherapy and radiation are subject to a 0% to 20% coinsurance, while covered insulin has a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Providence Medicare Focus Medical (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Providence Medicare Focus Medical (HMO) covers durable medical equipment and prosthetics with no copay and 20% coinsurance, subject to prior authorization. For diabetic equipment, some services are covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Providence Medicare Focus Medical (HMO) partially covers diagnostic and radiological services with prior authorization required and no copays for covered services. Covered diagnostic procedures and tests require a 20% coinsurance, and diagnostic and therapeutic radiological services have a 15% coinsurance, while lab services and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by the Providence Medicare Focus Medical (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Providence Medicare Focus Medical (HMO) with no coinsurance, but in practice only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, though they carry a $20 copay.
Skilled Nursing Facility (SNF) See details
Providence Medicare Focus Medical (HMO) covers skilled nursing facility (SNF) care with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Providence Medicare Focus Medical (HMO) partially covers other services, offering meal benefits for chronic illnesses and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit includes a $100 reimbursement allowance every six months, whereas the chronic illness meal benefit has no maximum limit.
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