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Providence Medicare Reverence (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Providence Medicare Reverence (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Providence Medicare Reverence (HMO-POS) in 2025, please refer to our full plan details page.
Providence Medicare Reverence (HMO-POS) is a HMO-POS plan offered by Providence St Joseph Health available for enrollment in 2025 to people living in Portland, Will Valley, Central OR, Clark, SE WA. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Providence Medicare Reverence (HMO-POS) 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 Reverence (HMO-POS).
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 Reverence (HMO-POS), 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 $5000.00 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 Reverence (HMO-POS).
Additional Benefits
The Providence Medicare Reverence (HMO-POS) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay, with no copay for days 7-90, and outpatient services have copays for different services. The plan also covers emergency services, primary care, preventive services, and more, with copays for services such as hearing exams, vision exams, and dental services. This plan provides coverage for services like home health, skilled nursing, and dialysis, with specific copays or coinsurance. Additionally, it includes benefits for medical equipment, home infusion, and other services like acupuncture and over-the-counter items. However, it's important to note that some services, such as certain hearing aids, vision services, and specific types of care, may not be covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-6 and no copay for days 7-90, and additional days have no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-6, and no copay for days 7-90, with additional days not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $250 copay, and observation services with a $90 copay per stay. Ambulatory Surgical Center (ASC) Services have a $250 copay, and outpatient substance abuse services have a $30 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Providence Medicare Reverence (HMO-POS) plan. You will pay a $55 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Providence Medicare Reverence (HMO-POS) plan. Ground and Air Ambulance Services have a copay of $50-$275, and there is no coinsurance; however, Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $125 copay, Urgently Needed Services has a $25 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Providence Medicare Reverence (HMO-POS) plan covers primary care physician services with a $15 copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, and physician specialist services with a $30 copay. The plan also covers mental health specialty services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services, each with varying copays. Podiatry services are not covered.
Preventive Services See details
The Providence Medicare Reverence (HMO-POS) plan covers preventive services, including Medicare-covered preventive services with prior authorization, annual physical exams, and additional preventive services with a copay for alternative therapies. Some services like health education, in-home safety assessments, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Additional benefits include coverage for personal emergency response systems, medical nutrition therapy, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and remote access technologies.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, and prescription hearing aids with a copay between $399 and $699. Routine hearing exams are limited to one per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids (all types) are limited to two per year. However, prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $30 copay, and eyewear with a combined maximum of $250 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Providence Medicare Reverence (HMO-POS) plan covers Medicare Dental Services with a $30 copay, and offers other dental services including oral exams with a $30 copay for up to 2 visits per year, dental x-rays, prophylaxis (cleaning) with a $30 copay for up to 2 visits per year, fluoride treatment with a $30 copay for 1 visit per year, and periodontics with a $30 copay for up to 2 visits per year. Orthodontic Services are covered, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Providence Medicare Reverence (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, Diabetic Equipment, and Diabetic Therapeutic Shoes/Inserts with 10% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a coinsurance, and for outpatient X-ray services with a $15 copay. Lab services are not covered, and diagnostic radiological services and therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Providence Medicare Reverence (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay for covered services is listed elsewhere in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Providence Medicare Reverence (HMO-POS) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $20 copay per visit, and OTC items have a maximum benefit of $75 every three months. The meal benefit is offered for chronic illnesses. Services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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