A non-government entity
Providence Medicare Choice + Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Providence Medicare Choice + 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 Choice + Rx (HMO-POS) in 2025, please refer to our full plan details page.
Providence Medicare Choice + Rx (HMO-POS) is a HMO-POS plan offered by Providence St Joseph Health available for enrollment in 2025 to people living in Portland, 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 Choice + 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 Choice + 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 Choice + Rx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $82.00. 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 $5000.00 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 Choice + Rx (HMO-POS) plan has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance for your prescriptions. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Providence Medicare Choice + Rx (HMO-POS) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay of $300 for days 1-6, and no copay for days 7-90. Outpatient services have copays that vary by service type, such as a $350 copay for outpatient hospital services and a $90 copay for observation services. The plan also includes coverage for emergency services with a $125 copay, along with primary care visits for $15. Hearing, vision, and dental services are also included, with copays for exams and coverage for hearing aids, eyewear, and dental procedures. There are additional benefits, such as home health services with no copay, and skilled nursing facility stays with a copay after 20 days.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $300 copay for days 1-6 and no copay for days 7-90, and for Inpatient Hospital Psychiatric, you'll pay a $275 copay for days 1-6 and no copay for days 7-90.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a $350 copay, observation services have a $90 copay, and ambulatory surgical center services have a $250 copay. Individual and group sessions for outpatient substance abuse have a copay between $30 and $30, and outpatient blood services have a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by the Providence Medicare Choice + Rx (HMO-POS) plan, but prior authorization is required. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a copay between $50.00 and $275.00, and no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered. Emergency Services have a $125 copay with no coinsurance, while Urgently Needed Services have a $25 copay with no coinsurance. 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 Choice + Rx (HMO-POS) plan covers primary care physician services with a $15 copay, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. Physician specialist services have a $30 copay, and physical therapy and speech-language pathology services have a $30 copay. Mental health and psychiatric services, other health care professional services, additional telehealth benefits, and opioid treatment program services are also covered with varying copays. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Health education, in-home safety assessments, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, 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 hearing exams with a $30 copay, and prescription hearing aids with a copay between $699 and $999, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids. Routine hearing exams are covered for 1 visit per year, and fitting/evaluation for hearing aids is unlimited.
Vision Services See details
Vision Services include coverage for eye exams with a $30 copay, and eyewear with a combined maximum benefit of $250 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Providence Medicare Choice + Rx (HMO-POS) plan covers a variety of dental services, including oral exams with a $30 copay, dental x-rays, prophylaxis (cleaning) with a $30 copay, and fluoride treatment with a $30 copay. Other diagnostic, preventive, restorative, adjunctive general, endodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery, and periodontics services are partially covered as optional, supplemental benefits. Orthodontics, maxillofacial prosthetics, and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including insulin and other Medicare Part B drugs, are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Providence Medicare Choice + Rx (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. All Diagnostic services have no copay, with a coinsurance of at most 20% for Diagnostic Procedures/Tests and Lab Services are not covered. All Radiological Services have a copay for Diagnostic Radiological Services and Outpatient X-Ray Services, and a coinsurance of at most 20% for Diagnostic Radiological Services and Therapeutic Radiological Services; Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Providence Medicare Choice + Rx (HMO-POS) plan with no copay and no coinsurance, but authorization is required. 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 Choice + Rx (HMO-POS) plan. The plan does not cover any of the sub-services associated with Cardiac Rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Providence Medicare Choice + Rx (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items with a maximum benefit of $30 every three months, and a meal benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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