Providence Health Assurance Medicare Advantage Plans Providence - - PowerPoint PPT Presentation
Providence Health Assurance Medicare Advantage Plans Providence Medicare Advantage Plans 2020 Plan Year Changes Medicare - Align Group Plan + Rx (HMO) and Flex Group Plan + Rx (HMO-POS) The Prescription Drug out-of-pocket maximum per person
Features Type of Plan Monthly Premium Out-of-Pocket Costs Provider Access Primary Care Physician Referral Requirement Align Group HMO Higher Premium Low In-Plan Only Required Referral Required
Flex Group HMO-POS Lower Premium Moderate In-Plan or Out-of-Plan Required Referral Optional
Benefit Coverage Align (HMO) Plan Flex (HMO-POS) Plan Member Responsibility In-Network Out-of-Network Deductible None None None Out-of-Pocket Maximum $1,500 per individual $3,000 per individual Primary Care Office Visit $15 copay $20 copay $30 copay Specialist Office Visit $20 copay $25 copay $35 copay Inpatient Hospitalization $100 copay per day $500 maximum per admit $125 copay per day $500 max per admit 20% Outpatient Surgery $75 copay $150 copay 20% Lab Tests $0 $0 20% X-ray 10% 10% 20% Pharmacy 40% of charge up to $250 maximum per 31-day supply Pharmacy Out-of-Pocket Maximum $6,350 per individual
Network Pharmacies* Walgreens Target Fred Meyer Wal-Mart Safeway Rite Aid Costco Bi-Mart
*Not all contracted network pharmacies are listed. Pharmacies contracted with your health plan may change at any time. Your health plan will notify you if your pharmacy is no longer included in the network. Please contact your health plan for more details.
*No coverage limit on emergency, urgent care or ambulance