A non-government entity
Providence Medicare Dual Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Providence Medicare Dual Plus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Providence Medicare Dual Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
Providence Medicare Dual Plus (HMO D-SNP) is a HMO D-SNP plan offered by Providence St Joseph Health available for enrollment in 2025 to people living in Clackamas, Multnomah, Washington counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Providence Medicare Dual Plus (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Providence Medicare Dual Plus (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Providence Medicare Dual Plus (HMO D-SNP).
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 Dual Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. 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.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 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
The Providence Medicare Dual Plus (HMO D-SNP) plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Knowing this upfront cost is essential when comparing Medicare drug coverage options to find the best fit for your healthcare budget. Specific drug coverage tier details, including individual copayments and coinsurance rates for different medication tiers, are not available for this plan. To fully understand your potential out-of-pocket expenses, you may want to contact the plan provider directly to verify how your specific prescriptions are covered. This ensures you have all the necessary cost details before enrolling in the Providence Medicare Dual Plus (HMO D-SNP) plan.
Additional Benefits
The Providence Medicare Dual Plus (HMO D-SNP) offers robust coverage with no copays for most medical services, though many benefits require a 20% coinsurance. Key services such as inpatient hospital stays, skilled nursing facility care, home health services, and preventive dental care up to $450 every six months are fully covered with no copay and no coinsurance. Other essential care, including primary care visits, outpatient services, emergency care, and durable medical equipment, features no copay but is subject to a 20% coinsurance. For supplemental benefits, the plan provides diagnostic hearing exams and routine eye exams with no copay, alongside up to $150 annually for eyewear and a $40 quarterly reimbursement for over-the-counter items. However, routine transportation, routine hearing exams, and hearing aids are not covered under this plan. Prior authorization is also required for many major services, including inpatient hospital stays, home health, and medical equipment.
Inpatient Hospital See details
Providence Medicare Dual Plus (HMO D-SNP) partially covers inpatient hospital services with no copayment and no coinsurance, requiring prior authorization for acute and psychiatric stays. While unlimited additional days for acute care are included, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Providence Medicare Dual Plus (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance and prior authorization apply to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are also covered with no copay and a 0% to 20% coinsurance, with the deductible waived for the first three pints of blood.
Partial Hospitalization See details
Providence Medicare Dual Plus (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Providence Medicare Dual Plus (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Routine transportation services, including trips to plan-approved or any health-related locations, are not covered under this plan.
Emergency Services See details
Emergency and urgently needed services are covered by Providence Medicare Dual Plus (HMO D-SNP) with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within 24 hours. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Providence Medicare Dual Plus (HMO D-SNP) covers primary care, specialist, mental health, therapy, and telehealth services with no copay and up to 20% coinsurance, though prior authorization is required for many benefits. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Providence Medicare Dual Plus (HMO D-SNP) offers partially covered preventive services, featuring an annual physical exam and select supplemental benefits with no copay and no coinsurance. While services like kidney disease education and glaucoma screenings have no copay and 20% coinsurance, other sub-services such as health education and in-home safety assessments are not covered.
Hearing Services See details
Providence Medicare Dual Plus (HMO D-SNP) provides partial coverage for hearing services, offering diagnostic hearing exams with no copay, no coinsurance, and no deductible. Routine hearing exams, fitting evaluations, prescription hearing aids, and over-the-counter (OTC) hearing aids are not covered under this plan.
Vision Services See details
Providence Medicare Dual Plus (HMO D-SNP) partially covers vision services with no deductible, offering one routine eye exam per year and eyewear with no copay. A 20% coinsurance applies to routine exams and contact lenses, which are covered alongside eyeglasses up to a $150 annual limit, though other eye exam services are not covered.
Dental Services See details
Dental services are covered by Providence Medicare Dual Plus (HMO D-SNP), with Medicare-covered dental requiring no copay and a 20% coinsurance. Preventive and comprehensive dental care, including exams, cleanings, and restorative services, are available with no copay and no coinsurance up to a maximum benefit of $450 every six months.
Home Infusion bundled Services See details
Providence Medicare Dual Plus (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, insulin, and other drugs, are covered with no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Providence Medicare Dual Plus (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Providence Medicare Dual Plus (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and some items may be limited to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Providence Medicare Dual Plus (HMO D-SNP) with no copayments and a 20% coinsurance for covered diagnostic procedures, X-rays, and radiological services. While these covered services require prior authorization, lab services are not covered under this benefit.
Home Health Services See details
Providence Medicare Dual Plus (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Providence Medicare Dual Plus (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but does not cover standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, or supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services, which all require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Providence Medicare Dual Plus (HMO D-SNP) covers Skilled Nursing Facility (SNF) care with no copayment and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days beyond the standard Medicare-covered limit are not covered, though the plan does allow for admission without a prior three-day inpatient hospital stay.
Other Services See details
Providence Medicare Dual Plus (HMO D-SNP) covers select other services, including chronic illness meal benefits and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit offers up to $40 every three months via reimbursement, while acupuncture and other additional services are not covered.
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