Providence Health Plan is an integrated delivery system of Providence Health & Services. They provide health care coverage to over 650,000 members all over the United States. Individuals and families can get Providence Medicare Advantage, which is a Medicare plan provided by the Providence Health Plan. With expert physicians, hospitals, and pharmacies, they deem to provide the best quality and affordable health care services.
Mission and Values of Providence Medicare Advantage:
Keeping the ministry of Jesus and God’s healing love, PHP serves people from all sectors, especially the poor and the vulnerable.
Providence Health Plan believes in the following values –
- Compassion
- Dignity
- Justice
- Excellence
- Integrity
Providence Medicare Advantage
Providence Health Plan offers a wide range of Medicare plans under the Providence Medicare Advantage plans. There are divided into several categories based on service areas. Let’s take a look at the various Providence Medicare Advantage plans:
Service Area 1
Clackamas, Multnomah, Washington, and Yamhill counties in Oregon
Prime + Rx (HMO):
| Benefits | You Pay |
| Out-of-pocket maximum | $5,900 |
| Doctor office visit (PCP) | $0 |
| Specialist visit | $40 |
| Alternative Care | $20 – $40 |
| Outpatient diagnostic tests & procedures | 20% |
| Outpatient diagnostic & therapeutic radiology | 20% |
| Inpatient hospital | Days 1-4: $450/day, Days 5-beyond: $0 |
Bridge 1 + Rx (HMO-POS):
| Benefits | You Pay | |
| In-Network | Out-of-Network | |
| Out-of-pocket maximum | $4,900 | $10,000 |
| Doctor office visit (PCP) | $0 | $25 |
| Specialist visit | $35 | $50 |
| Alternative Care | $20-$35 | No coverage |
| Outpatient diagnostic tests & procedures | 20% | 30% |
| Outpatient diagnostic & therapeutic radiology | 20% | |
| Inpatient hospital | Days 1-6: $325/day Days 7 & beyond: $0 | 30% |
Service Area 2
Columbia, Lane, Marion, Polk counties in Oregon and Clark County in Washington
Timber + Rx (HMO):
| Benefits | You Pay |
| Out-of-pocket maximum | $5,500 |
| Doctor office visit (PCP) | $0 |
| Specialist visit | $40 |
| Alternative Care | $20 – $40 |
| Outpatient diagnostic tests & procedures | 20% |
| Outpatient diagnostic & therapeutic radiology | 20% |
| Inpatient hospital | Days 1-4: $450/day, Days 5-beyond: $0 |
Choice + Rx 002 (HMO-POS):
| Benefits | You Pay | |
| In-Network | Out-of-Network | |
| Out-of-pocket maximum | $4,500 | $10,000 combined |
| Doctor office visit (PCP) | $15 | $25 |
| Specialist visit | $30 / $50 no referral | $50 |
| Outpatient diagnostic tests & procedures | 20% | 30% |
| Outpatient diagnostic & therapeutic radiology | 20% | 30% |
| Inpatient hospital | Days 1-6: $300/day Days 7 & beyond: $0 | 30% |
Service Area 3
Benton and Linn counties in Oregon
Enrich + Rx (HMO):
| Benefits | You Pay |
| Out-of-pocket maximum | $5,000 |
| Doctor office visit (PCP) | $15 |
| Specialist visit | $40 |
| Outpatient diagnostic tests & procedures | 20% |
| Outpatient diagnostic & therapeutic radiology | 20% |
| Inpatient hospital | Days 1-5: $350/day, Days 6 and beyond: $0 |
Service Area 4
Crook, Deschutes, Hood River, Jefferson, and Wheeler counties in Oregon
Compass + Rx (HMO-POS):
| Benefits | You Pay | |
| In-Network | Out-of-Network | |
| Out-of-pocket maximum | $5,900 | $10,000 combined |
| Doctor office visit (PCP) | $10 | $25 |
| Specialist visit | $40 / $50 no referral | $50 |
| Outpatient diagnostic tests & procedures | 0% | 30% |
| Outpatient diagnostic & therapeutic radiology | 20% | 30% |
| Inpatient hospital | Days 1-5: $360/day Days 6 & beyond: $0 | 30% |
Latitude + Rx (HMO-POS):
| Benefits | You Pay | |
| In-Network | Out-of-Network | |
| Out-of-pocket maximum | $5,500 | $5,500 combined |
| Doctor office visit (PCP) | $10 | $25 |
| Specialist visit | $40 / $50 no referral | $50 |
| Outpatient diagnostic tests & procedures | 20% | 30% |
| Outpatient diagnostic & therapeutic radiology | 15% | 30% |
| Inpatient hospital | Days 1-5: $275/day Days 6 & beyond: $0 | 30% |
Service Area 5
Snohomish County in Washington
Harbor + Rx (HMO):
| Benefits | You Pay |
| Out-of-pocket maximum | $6,700 |
| Doctor office visit (PCP) | $10 |
| Specialist visit | $50 |
| Outpatient diagnostic tests & procedures | 20% |
| Outpatient diagnostic & therapeutic radiology | 20% |
| Inpatient hospital | Days 1-4: $450/day, Days 5-beyond: $0 |
Summit + Rx (HMO-POS):
| Benefits | You Pay | |
| In-Network | Out-of-Network | |
| Out-of-pocket maximum | $5,500 | $10,000 combined |
| Doctor office visit (PCP) | $5 | $25 |
| Specialist visit | $40 / $50 no referral | $50 |
| Outpatient diagnostic tests & procedures | 20% | 40% |
| Outpatient diagnostic & therapeutic radiology | 20% | 40% |
| Inpatient hospital | Days 1-4: $375/day Days 5 & beyond: $0 | 40% |
Service Area 6
Spokane County in Washington
Pine + Rx (HMO):
| Benefits | You Pay |
| Out-of-pocket maximum | $5,500 |
| Doctor office visit (PCP) | $0 |
| Specialist visit | $45 |
| Outpatient diagnostic tests & procedures | 20% |
| Outpatient diagnostic & therapeutic radiology | 20% |
| Inpatient hospital | Days 1-4: $395/day Days 5-beyond: $0 |
Cottonwood + Rx (HMO-POS):
| Benefits | You Pay | |
| In-Network | Out-of-Network | |
| Out-of-pocket maximum | $4,800 | $10,000 |
| Doctor office visit (PCP) | $0 | $25 |
| Specialist visit | $35° | $50 |
| Outpatient diagnostic tests & procedures | 20% | 30% |
| Outpatient diagnostic & therapeutic radiology | 20% | 30% |
| Inpatient hospital | Days 1-6: $325/day Days 7-beyond: $0 | 30% |
Medical only, No Rx Area
Clackamas, Columbia, Lane, Marion, Multnomah, Polk, Washington, Yamhill counties in Oregon and Clark County in Washington
Focus Medical (HMO):
| Benefits | You Pay |
| Out-of-pocket maximum | $3,400 |
| Doctor office visit (PCP) | $0 |
| Specialist visit | $20 |
| Alternative Care | $20 – $40 |
| Outpatient diagnostic tests & procedures | 20% |
| Outpatient diagnostic & therapeutic radiology | 15% |
| Inpatient hospital | Days 1-5: $250/day Days 6 & beyond: $0 |
Select Medical (HMO-POS):
| Benefits | You Pay | |
| In-Network | Out-of-Network | |
| Out-of-pocket maximum | $4,500 | $10,000 combined |
| Doctor office visit (PCP) | $15 | $25 |
| Specialist visit | $30 / $50 no referral | $50 |
| Alternative Care | $20 – $30 | $50 |
| Outpatient diagnostic tests & procedures | 20% | 30% |
| Outpatient diagnostic & therapeutic radiology | 20% | 30% |
| Inpatient hospital | Days 1-6: $300/day Days 7 & beyond: $0 | 30% |
D-SNP Area
Clackamas, Multnomah, and Washington counties in Oregon
Dual Plus (HMO D-SNP):
| Medical Benefits | You Pay |
| Annual wellness visit | $0 |
| Primary care physician (PCP) visits | $0 or 20% |
| Specialist visits | $0 or 20% |
| Diabetic supplies | $0 |
| Outpatient surgery and hospital services | $0 |
| Inpatient hospital | $0 |
| Transportation (max. of 25 miles each way) | $0 (36 one-way trips) |
Providence Medicare Advantage plans are very cost-effective and helpful for downtrodden people. Their wide Medicare plans provide robust benefits for the members. To know more about Providence Medicare Advantage plans, visit https://healthplans.providence.org/medicare/plans/compare/.
Frequently Ask Questions:
- How do I enroll with Providence Medicare Advantage?
You can enroll with Providence Medicare Advantage through their secure enrollment form or by calling 1-800-457-6064 (TTY: 711).
- How do I mail to Providence Medicare Advantage?
If you want to contact Providence Medicare Advantage Plan by mail, you can use the following address –
Providence Medicare Advantage Plans
P.O. Box 4327
Portland, OR 97208-4327.
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