A non-government entity
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 2026, 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 Metro, SE WA, Clark WA, Hood River, Lane. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $6750.00 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 comprehensive medical coverage with predictable cost-sharing, featuring no coinsurance for many primary services. Members benefit from no copay for preventive care, home health services, and routine dental care, while primary care visits require a low $15 copay. Inpatient hospital stays require a daily copay for the first six days, followed by no copay for subsequent days. Specialist visits, routine vision exams, and routine hearing tests are available with a $30 copay and no coinsurance. The plan also includes valuable extras, such as a $250 annual eyewear allowance and a $100 over-the-counter allowance every six months with no copay. Diagnostic services, dialysis, and durable medical equipment generally require a ten to twenty percent coinsurance with no copay.
Inpatient Hospital See details
Providence Medicare Reverence (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1-6 for acute stays and a $275 daily copay for days 1-6 for psychiatric stays, followed by no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Providence Medicare Reverence (HMO-POS) with no coinsurance, featuring a $250 copay for outpatient hospital and ambulatory surgical center services, and a $90 copay per stay for observation services. Outpatient substance abuse services require a $30 copay per session with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Providence Medicare Reverence (HMO-POS) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Providence Medicare Reverence (HMO-POS) covers ground and air ambulance services with a copay of $50.00 to $275.00 and no coinsurance, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Providence Medicare Reverence (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $25 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $25, and $275, respectively, under an unlimited maximum plan benefit.
Primary Care See details
Providence Medicare Reverence (HMO-POS) provides partially covered primary care benefits with no coinsurance across all covered services, though chiropractic and podiatry services are not covered. Members pay a $15 copay for primary care physician visits, a $30 copay for specialists, physical therapy, occupational therapy, and mental health sessions, and between no copay and a $30 copay for telehealth and opioid treatment.
Preventive Services See details
Providence Medicare Reverence (HMO-POS) provides coverage for preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, excluding benefits such as health education, in-home safety assessments, weight management programs, and therapeutic massage.
Hearing Services See details
Providence Medicare Reverence (HMO-POS) covers annual routine hearing exams with a $30 copay and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are partially covered with a copay of $499 to $999 and no coinsurance for up to two devices per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Providence Medicare Reverence (HMO-POS) partially covers vision services, as other eye exam services are not covered. Covered benefits include one routine eye exam per year for a $30 copay and no coinsurance, alongside eyewear—including contacts, frames, lenses, and upgrades—with no copay and no coinsurance up to a $250 annual limit.
Dental Services See details
Providence Medicare Reverence (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $30 copay and no coinsurance, and other preventive and comprehensive dental services with no copay and no coinsurance. While exams, cleanings, x-rays, and endodontics are covered, implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Providence Medicare Reverence (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, feature a coinsurance ranging from no coinsurance up to 20%, with insulin specifically carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Providence Medicare Reverence (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Providence Medicare Reverence (HMO-POS) partially covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, and a 10% coinsurance for diabetic therapeutic shoes and inserts. Prior authorization is required for these benefits, preferred manufacturer rules apply, and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Providence Medicare Reverence (HMO-POS) partially covers diagnostic and radiological services, with lab services not covered and prior authorization required for all other services. Diagnostic procedures and therapeutic radiological services carry a 20% coinsurance with no copay, outpatient x-rays require a $15 copay, and diagnostic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Home health services are covered by Providence Medicare Reverence (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Providence Medicare Reverence (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, though some services are covered while cardiac rehabilitation ($10 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy (SET) for peripheral artery disease (PAD) services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Providence Medicare Reverence (HMO-POS) with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the Medicare limit are not covered.
Other Services See details
Other Services are partially covered by Providence Medicare Reverence (HMO-POS), which provides a chronic illness meal benefit and an over-the-counter (OTC) allowance of $100 every six months with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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