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 2025, 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 Willamette Valley, Central OR, Clark, WA. This plan received an overall rating of 4 out of 5 stars in 2025.
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 $6000.00 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 a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $10 copay for preferred generic drugs at a preferred pharmacy, and 30% coinsurance for non-preferred drugs. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Providence Medicare Timber + Rx (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with the cost dependent on the length of stay. Outpatient services and emergency services also have copays, while many primary care services, preventive services, and home health services are covered with no copay. The plan also covers hearing, vision, and dental services, each with specific copays or coinsurance. Other benefits include ambulance services, partial hospitalization, and coverage for medical equipment and diagnostic services. This plan also covers skilled nursing facility stays, acupuncture, and over-the-counter items.
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 $450 copay for days 1-4, and no copay for days 5-90, and for Inpatient Hospital Psychiatric, you will pay a $320 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $450 copay, Observation Services with a $90 copay, and Ambulatory Surgical Center (ASC) Services with a $250 copay. Outpatient Substance Abuse Services are covered with a copay of $40 for both individual and group sessions, and Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Providence Medicare Timber + Rx (HMO) plan, and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground and air ambulance services have a copay between $50.00 - $275.00, with no coinsurance. 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 by the Providence Medicare Timber + Rx (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $25 copay, while 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
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $20 copay, and routine chiropractic care has a $20 copay for up to 18 visits per year. Occupational Therapy Services have a $40 copay, Physician Specialist Services have a $40 copay, and Physical Therapy and Speech-Language Pathology Services have a $40 copay. For Mental Health Specialty Services and Psychiatric Services, individual and group sessions have a $40 copay. Other Health Care Professional services have a copay between $0 and $40, and Opioid Treatment Program Services have a copay between $0 and $40. Additional Telehealth Benefits have a copay between $0 and $40. Podiatry Services are not covered.
Preventive Services See details
The Providence Medicare Timber + Rx (HMO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services are also covered, but some services like health education, in-home safety assessments, and weight management programs are not covered. Alternative therapies have a $20 copay per visit for up to 6 visits.
Hearing Services See details
Hearing services include routine hearing exams with a $40 copay, fitting/evaluation for hearing aids, and prescription hearing aids. Prescription hearing aids (all types) have a copay between $699 and $999, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear with 20% coinsurance for contact lenses and a combined maximum benefit of $250 per year, with coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
Dental Services are covered, including a $40 copay for Medicare Dental Services. Other covered services include oral exams (2 visits per year), dental x-rays (2 per year), prophylaxis (cleaning) (2 visits per year), fluoride treatment (1 per year), restorative services, adjunctive general services, endodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics. Orthodontic services have a maximum benefit of $225 per year. Other diagnostic dental services and other preventive dental services are optional and supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Providence Medicare Timber + Rx (HMO). For Medicare Part B Insulin Drugs, you will pay a $35 copay plus 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Providence Medicare Timber + Rx (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Providence Medicare Timber + Rx (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, with no copay, and requires authorization. Prosthetic devices have a 20% coinsurance, while medical supplies have a 20% coinsurance, both with no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and no copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
The Providence Medicare Timber + Rx (HMO) plan covers diagnostic and radiological services, but lab services are not covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Therapeutic Radiological Services also have a coinsurance of at most 20%. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Providence Medicare Timber + Rx (HMO) plan, with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Providence Medicare Timber + Rx (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Providence Medicare Timber + Rx (HMO) plan, but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a copay of $214.
Other Services See details
The Providence Medicare Timber + Rx (HMO) plan covers acupuncture with a $20 copay for up to 18 treatments per year. The plan also covers over-the-counter items, including nicotine replacement therapy and naloxone, with a maximum benefit of $80 every three months. Additionally, this plan offers a meal benefit for chronic illnesses. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, and many other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management.
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