Providence Medicare Extra + Rx (HMO)

Providence Medicare Extra + Rx (HMO) is a HMO plan offered by Providence St Joseph Health available for enrollment in 2025 to people living in Portland Metro, Lane, Hood River, Clark WA. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that Providence Medicare Extra + 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 Extra + 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.

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:

Drug Coverage

The Providence Medicare Extra + Rx (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics, you will pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $12 copay for a one-month supply. Tier 2 generic drugs also feature no copay for standard mail orders, but cost a $10 copay at preferred pharmacies and a $20 copay at standard pharmacies for a one-month supply. Tier 3 preferred brand drugs require a $40 copay at preferred pharmacies and standard mail order, or a $47 copay at standard pharmacies for a one-month supply. Tier 4 non-preferred drugs cost a $90 copay at preferred pharmacies and standard mail order, compared to a $100 copay at standard pharmacies. Specialty medications in Tier 5 require a 33% coinsurance for a one-month supply across preferred, standard, and standard mail-order options.

Additional Benefits

The Providence Medicare Extra + Rx (HMO) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits and home health services. For specialist visits, physical therapy, and routine vision and hearing exams, members pay a low $20 copay with no coinsurance. Inpatient hospital stays require a $250 daily copay for the first five days, while outpatient hospital services carry a $150 copay, both with no coinsurance. This plan also includes valuable supplemental benefits, such as a $150 annual eyewear allowance and prescription hearing aid coverage with copays ranging from $499 to $999. Beneficiaries receive a $240 over-the-counter allowance every six months and preventive dental services with no copay or coinsurance. For specialized medical needs, durable medical equipment and dialysis require a 20% coinsurance with no copay, while skilled nursing facility stays feature no copay for the first 20 days.