2025 plan comparison
This is only a brief comparison of benefits. Medicare coverage rules apply to the benefits listed below, for instance, you must continue to pay your Medicare Part B premium.
|
Providence Medicare Align Group Plan + Rx (HMO) |
Providence Medicare Flex Group Plan + Rx |
||
|---|---|---|---|
| In-network | In-network | Out-of-network | |
| Out-of-pocket maximum | $1,500 | $3,000 combined in- and out-of-network | |
| Deductible | $0 | $0 | |
| Benefits | You pay | You pay | |
| Fitness center membership | $0 | $0 | No coverage |
| Doctor's office visit (PCP) | $15 | $20 | $30 |
| Specialist Visit | $20 | $25 | $35 |
| Virtual Visits | $0 | $0 | No coverage |
| Preventive Care | $0 | $0 | $0 |
| Lab | $0 | $0 | 20% |
| X-ray | 10% | 10% | 20% |
| Durable Medical Equipment | 20% | 20% | 20% |
| Diabetic Supplies | $0 | $0 | 20% |
| Outpatient Surgery | $75 | $150 | 20% |
| Inpatient Hospital | Days 1-5: $100 Days 6 and beyond: $0 |
Days 1-4: $125 Days 5 and beyond: $0 |
20% |
| Skilled Nursing Facility | Days 1-100: $0 | Days 1-20: $0 Days 21-100: $50/day |
20% |
| Home Health | $0 | 10% | 20% |
| Mental health and chemical dependency counseling | $20 | $25 | $35 |
| Therapy: PT, OT, ST | $20 | $25 | $35 |
| Chiropractic (Medicare covered only) | $20 | $20 | $35 |
| Podiatry (Medicare covered only) | $20 | $25 | $35 |
| Cardiac Rehabilitation (Medicare covered only) | $20 | $25 | $35 |
| Pulmonary Rehabilitation (Medicare covered only) | $20 | $20 | $35 |
| Part B Medications | 0%-20% (Insulin cost share up to $35 per month) |
0%-20% (Insulin cost share up to $35 per month) |
20% (Insulin cost share up to $35 per month) |
| Hearing Services (Medicare-covered) | $20 | $25 | $35 |
| Routine Hearing Exam | $0 | $0 | No coverage |
| Hearing aids | $399 – Advanced $699 – Premium |
$399 – Advanced $699 – Premium |
No coverage |
| Medicare-covered Eye Exam | $20 | $25 | $35 |
| Routine Eye Exam | $15 | $20 | $20 |
| Prescription Eyeglasses (lenses, frames, upgrades) | Covered up to $200 – every two years | Covered up to $200 – every two years |
|
| Contact Lenses – in lieu of glasses | Covered up to $200 – every two years | Covered up to $200 – every two years |
|
| Worldwide Coverage | |||
| Urgent Care* | $25^ | $25^ | $25^ |
| Emergency Room* | $50^ | $65^ | $65^ |
| Ambulance (air/ground) | $50 | $50 | $50 |
*Diagnostic imaging may apply.
^Copayment is waived if admitted within 24 hours for the same condition.
Providence Medicare Advantage Plans is an HMO, HMO‐POS and HMO SNP with Medicare and Oregon Health Plan contracts. Enrollment in Providence Medicare Advantage Plans depends on contract renewal.