2020 Medicare Advantage Plan Comparison/media/Files... · 02 . ProvidenceHealthAssurance.com...
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2020 Medicare Advantage Plan Comparison Providence Medicare Pine + Rx (HMO) Providence Medicare Cottonwood + Rx (HMO) Service area: Spokane County in Washington H9047_2020PHA16_C MDC-383
Transcript of 2020 Medicare Advantage Plan Comparison/media/Files... · 02 . ProvidenceHealthAssurance.com...
2020 Medicare Advantage Plan Comparison
Providence Medicare Pine + Rx (HMO) Providence Medicare Cottonwood + Rx (HMO)
Service area: Spokane County in Washington
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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.
Variety of plans and options We designed our plans with your needs and budget in mind with different plan types and cost sharing options (deductibles, coinsurance and copayments), there's a plan for everyone.
Broad network With access to thousands of network providers, you'll find quality care when you need it.
Care for you and the community We care about the total well-being of each person we serve. That’s why we donate vital health care services that support the issues and challenges of our local communities.
Experience and innovation We're part of Providence St. Joseph Health so you benefit from more than 160 years of health care experience and innovation. With our broad resources, you'll get modern conveniences, like telemedicine, and integrated systems that make it simpler for you to get the very best care possible.
Why choose Providence? Medicare choices can be confusing. So we’re here to make it easier. Providence Medicare Advantage Plans support you every step of the way. You’re covered, whenever and wherever you need care. Plus, you'll get extra features and convenient tools to help you live well.
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Spokane
2020 Providence Medicare Service Area Map
+ Pine + Rx (HMO) + Cottonwood + Rx (HMO)
Visit ProvidenceHealthAssurance.com for more information.
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Other charges and limits may apply. See Evidence of Coverage for more information. Out-of-network/non-contracted providers are under no obligation to treat Providence Medicare Advantage Plans members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.
Providence Medicare Advantage Plans – Part CProvidence Medicare
Pine + Rx (HMO)Providence Medicare
Cottonwood + Rx (HMO)Monthly premium with prescription drug coverage
$0 $35
In-network In-network
Medical Deductible $0 $0
Out-of-pocket maximum $5,500 $4,800
Benefits You pay You pay
Doctor office visit (PCP) $0 $0
Specialist visit $45 $35
Preventive care $0 $0
Inpatient hospitalDays 1-4: $395/day
Day 5 and beyond: $0/dayDays 1-6: $325/day
Day 7 and beyond: $0/day
Skilled nursing facilityDays 1-20: $0/day
Days 21-100: $172/dayDays 1-20: $0/day
Days 21-100: $160/day
Outpatient surgery $310 20%
Diabetic supplies $0 – 20% $0 – 20%
Lab $0 $0
X-ray $10 $0
Outpatient diagnostic tests and procedures
$0 $0
Alternative care No coverage $20 – $35; $500 annual maximum
Therapy: PT, OT, ST $40 $35
Durable medical equipment 20% 20%
Chiropractic $20 $20
Home health $0 $0
Secure video visits $0 $0
No-cost fitness center
membership included $0 $0
Preventive dental $15 $15
Worldwide coverage Worldwide coverage
Urgent care $50 $50
Emergency room $90 $70
Ambulance (air/ground) $50 – $250 one way $50 – $250 one way
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Initial coverage Coverage gap Catastrophic coverage
Phase 1 Phase 2 Phase 3When the total paid by you and the plan reaches $4,020, Phase 2 begins.
You pay only 25% of the costs of brand-name drugs and 25% of the costs of generic drugs. You stay in this stage until your out-of-pocket costs reach $6,350. After that, Phase 3 begins.
You pay whichever of these is larger: either 5% coinsurance for the costs of the drug or $3.60 copay for generic drugs; $8.95 copay for brand-name or specialty drugs.
Providence Medicare Pine + Rx (HMO)
Providence Medicare Cottonwood + Rx (HMO)
Annual deductible† † $190 (waived on generic tiers) $140 (waived on generic tiers)
30-day 90-day 30-day 90-day
Preferred generic $0 $0 $0 $0
Generic $10 $10 $10 $10
Preferred brand $47 $141 $47 $141
Non-preferred drugs $100 $300 $100 $300
Specialty drugs 29% N/A 30% N/A
Providence Medicare Pine + Rx (HMO)
Providence Medicare Cottonwood + Rx (HMO)
Routine hearing exam (one per year) $0 $0
Hearing aids (up to two hearing aids per year)
$499 or $799 per hearing aid $399 or $699 per hearing aid
Providence Medicare Pine + Rx (HMO)
Providence Medicare Cottonwood + Rx (HMO)
Routine eye exams Up to $75 allowance Up to $75 allowance
Prescription eyeglasses or contact lenses $110 allowance per year $210 allowance per year
† † Deductible is waived on all generic tiers (Tiers 1 and 2). Copays listed are for Preferred Network pharmacies only; other pharmacy copays may cost more.
You are responsible for any cost above the allowance for routine eye exams, prescription eyeglasses or contact lenses.
You must see a TruHearing provider.
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.
Pharmacy coverage – Part D
Vision coverage – included at no extra charge
Hearing coverage – included at no extra charge
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Plans that include Wrap options: Pine + Rx, Cottonwood + Rx
Basic Wrap Enhanced Wrap
Monthly premium $29.20 $42.10
Plan benefitsIn-network
member responsibility
Out-of-network member
responsibility*
In-network member
responsibility
Out-of-network member
responsibility*
Office visit copay No copay No copay
Annual deductible1 $50 $150 $50 $150
Annual maximum $1,000 $1,500
Waiting periods None None
Provider network Any licensed dentist2 Any licensed dentist2
Out-of-network reimbursement Maximum allowable charge Maximum allowable charge
Diagnostic and Preventive Services
Oral examinations3 0% 20% 0% 20%
Bitewing X-rays4 0% 20% 0% 20%
Panoramic and other diagnostic X-rays5 0% 20% 0% 20%
Comprehensive Dental ServicesBasic fillings and simple extractions 50% 60% 50% 60%
Dentures6 50% 60% 50% 60%
Crowns and bridges7 50% 60% 50% 60%
Oral surgery Not covered 50% 60%
Endodontics (root canals) Not covered 50% 60%
Periodontics Not covered 50% 60%
2020 Optional Supplemental Dental Benefits
*Important notes: Out-of-network dentists may charge more than the amount allowed by Providence Medicare Advantage Plans. If this happens, they may send members a "balance bill" for the difference between their charged amount and the amount paid by the plan. 1 Deductibles are waived for diagnostic and preventive services 2 Seeking care from a participating in-network dentist will reduce out-of-pocket costs and prevent a balance bill 3 Oral examinations – limited to one per calendar year 4 Bitewing or Periapical X-rays – limited to one bitewing and two periapical per calendar year 5 Panoramic or other diagnostic X-rays – limited to one per five years 6 $250 lifetime denture benefit 7 Crown/bridge max. (Basic) – $100 per tooth per year; crown/bridge max. (Enhanced) – $500 per year
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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.
Benefits and services beyond Original Medicare Put all the perks of Providence Medicare Advantage Plans to work for you. From achieving better health and fitness to accessing coaching and support, our plans bring these extras and more:
Savings and assistance with My Advocate®
which connects members with a variety of government and community programs.
Optional home assessments
with licensed, board-certified nurses.
Annual routine eye exam
offered on all plans and an allowance for prescription glasses, frames and/or contacts on some plans.
Providence Express Care Virtual and Express Care
no-cost, on-demand provider visits from your computer or smartphone, or visit one of our Express Care clinics for same-day care in many locations.
myProvidence
so you can access a summary of your benefits, view claims, pay your premium and get prescription drug information.
Health coaching
can help you lose weight, increase your physical activity or just feel better when you join the 92 percent of Providence health coaching participants who’ve made a lifestyle improvement.
Annual routine hearing exam and hearing aid benefit
provides you with high-qualityhearing aids and local professionalcare at a fraction of the cost.
No-cost fitness center membership
so you can work out your way, or even work out at home using two home-fitness kits per year.
24/7 nurse advice
so you can connect with registered nurses day or night with no cost to you.
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Call us for information, to enroll, or to make a personal appointment at 833-978-0107 8 a.m. to 8 p.m. (Pacific Time), seven days a week (Oct. 1 – Dec. 7); Monday – Friday (Dec. 8 – Sept. 30) Enroll online at ProvidenceHealthAssurance.com
Our ValuesCompassion | Dignity | Justice | Excellence | Integrity
Our MissionAs expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
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