A non-government entity
Providence Medicare Cottonwood + Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Providence Medicare Cottonwood + Rx (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 Cottonwood + Rx (HMO-POS) in 2025, please refer to our full plan details page.
Providence Medicare Cottonwood + Rx (HMO-POS) is a HMO-POS plan offered by Providence St Joseph Health available for enrollment in 2025 to people living in SE WA, Spokane and Snohomish counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Providence Medicare Cottonwood + Rx (HMO-POS) 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 Cottonwood + Rx (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 Cottonwood + Rx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 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 Cottonwood + Rx (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies depending on the drug tier and pharmacy. For example, you'll pay a $10 copay at a preferred pharmacy for preferred generic drugs, while standard mail order has no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), the monthly premium is $0.90.
Additional Benefits
The Providence Medicare Cottonwood + Rx (HMO-POS) plan offers comprehensive coverage with a variety of benefits. This plan includes inpatient hospital stays with a $325 copay, outpatient services, and mental health services with a $35 copay. The plan also provides coverage for emergency services, primary care visits, and preventive services, with no copay for Medicare-covered preventive services. Additional benefits include hearing exams with a $35 copay, vision care, and dental services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-6, and no copay for days 7-90, and additional days 91-999 have no copay. For Inpatient Hospital Psychiatric, you pay a $325 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stay 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 are covered, including outpatient hospital services with a $290 copay, observation services with a $70 copay, ambulatory surgical center (ASC) services with a $250 copay, and outpatient substance abuse services with a $35 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 Cottonwood + Rx (HMO-POS) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Providence Medicare Cottonwood + Rx (HMO-POS) plan. Both ground and air ambulance services have a copay between $50 and $275, and no coinsurance, while 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 have a $125 copay, Urgently Needed Services have a $25 copay, and 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 Cottonwood + Rx (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and mental health specialty services, psychiatric services, and opioid treatment program services with a copay of $35 for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, and other healthcare professional services have a copay between $0 and $35. Additional telehealth benefits are covered with a copay between $0 and $35. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional covered services include Personal Emergency Response System, Medical Nutrition Therapy, Wigs for Hair Loss Related to Chemotherapy, Alternative Therapies with a $20 copay, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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.
Hearing Services See details
Hearing services include routine hearing exams with a $35 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types, but not for inner ear, outer ear, or over-the-ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with a $35 copay, and coverage for eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $250 every year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Orthodontic Services with a maximum plan benefit coverage of $875 per year, and other services. Other Diagnostic Dental Services and Other Preventive Dental Services are available as optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, you pay a $35 copay, and between 0% and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Providence Medicare Cottonwood + Rx (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered under the Providence Medicare Cottonwood + Rx (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Providence Medicare Cottonwood + Rx (HMO-POS) plan with no copay and no coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay for these services is listed separately.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Providence Medicare Cottonwood + Rx (HMO-POS) plan, requiring prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Providence Medicare Cottonwood + Rx (HMO-POS) plan covers acupuncture with a $20 copay for up to 18 treatments per year, over-the-counter items with a maximum benefit of $70 every three months, and a meal benefit for chronic illness. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management (Long Term Care).
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