A non-government entity
Providence Medicare Timber + Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Providence Medicare Timber + Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Providence Medicare Timber + Rx (HMO) in 2026, please refer to our full plan details page.
Providence Medicare Timber + Rx (HMO) is a HMO plan offered by Providence St Joseph Health available for enrollment in 2025 to people living in Lane, Hood River, Clark WA counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Providence Medicare Timber + Rx (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Providence Medicare Timber + Rx (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 Timber + Rx (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.
This plan has a $250.00 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 $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
The Providence Medicare Timber + Rx (HMO) plan has an annual drug deductible of $250. For Tier 1 preferred generic drugs, you pay no copay at preferred pharmacies or through standard mail order. Tier 2 generic drugs also have no copay for standard mail order, or you can pay a $10 copay for a one-month supply at preferred pharmacies. Tier 3 preferred brand drugs cost a $47 copay for a one-month supply at retail pharmacies, or a lower $40 copay through standard mail order. Tier 4 non-preferred drugs require a $100 copay for a one-month supply at preferred, standard, and standard mail order pharmacies. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply.
Additional Benefits
The Providence Medicare Timber + Rx (HMO) plan offers comprehensive coverage with no copay for primary care physician visits, annual physicals, and covered preventive services. For specialized care, members pay a $40 copay for specialist visits, routine hearing exams, and routine eye exams. Inpatient acute hospital stays require a $450 daily copay for the first four days followed by no copay, while outpatient hospital services carry a $450 copay. Preventive dental care like cleanings and exams is available with no copay, and home health services are also fully covered with no copay. For other medical needs, diagnostic services, dialysis, and medical equipment generally require a 20% coinsurance with no copay. Emergency room visits are covered with a $130 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
Providence Medicare Timber + Rx (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $450 daily copay for days 1 to 4 with no copay for additional days, while psychiatric stays require a $320 daily copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
Providence Medicare Timber + Rx (HMO) covers outpatient services with no coinsurance, including outpatient hospital services for a $450 copay, observation services for a $90 copay per stay, and ambulatory surgical center services for a $250 copay. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Providence Medicare Timber + Rx (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Providence Medicare Timber + Rx (HMO) covers ground and air ambulance services with a copayment ranging from $50.00 to $275.00 and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Providence Medicare Timber + Rx (HMO) 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.
Primary Care See details
Providence Medicare Timber + Rx (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, mental health sessions, and physical therapy require a $40 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Providence Medicare Timber + Rx (HMO) with no copay and no coinsurance for covered services like annual physicals and glaucoma screenings. However, sub-services such as health education, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, and in-home support are not covered.
Hearing Services See details
Providence Medicare Timber + Rx (HMO) partially covers hearing services, including one routine hearing exam per year for a $40 copay and no coinsurance, and up to two prescription hearing aids per year with a copay of $499 to $999 and no coinsurance. However, over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Providence Medicare Timber + Rx (HMO), offering one routine eye exam per year for a $40 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including eyeglasses and contact lenses, features no copay and a 20% coinsurance for contact lenses up to a $100 annual maximum.
Dental Services See details
Dental services are partially covered by Providence Medicare Timber + Rx (HMO), featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive care like exams and cleanings. While many restorative and surgical options are covered, orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Providence Medicare Timber + Rx (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Providence Medicare Timber + Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Providence Medicare Timber + Rx (HMO) with no copay and a 20% coinsurance, subject to prior authorization. This benefit is partially covered because diabetic supplies are not covered, though durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered.
Diagnostic and Radiological Services See details
Providence Medicare Timber + Rx (HMO) partially covers diagnostic and radiological services with prior authorization required, though lab services are not covered. Covered diagnostic procedures and therapeutic radiological services require a 20% coinsurance with no copay, while outpatient X-rays require a $15 copay and 20% coinsurance, and diagnostic radiological services incur a 20% coinsurance and a copay.
Home Health Services See details
Home health services are covered by Providence Medicare Timber + Rx (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 Timber + Rx (HMO) with no copay and no coinsurance, though only some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Providence Medicare Timber + Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the Medicare limit.
Other Services See details
Other Services, including acupuncture, over-the-counter (OTC) items, and meal benefits, are not covered under the Providence Medicare Timber + Rx (HMO) plan.
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