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 per calendar year is $6,350 • Routine hearing exam covered after $45 copay. Must use TruHearing providers. – One routine exam per calendar year. • Hearing aid hardware options ($699 or $999) are available. Must use TruHearing providers. – Up to two aids per calendar year.
The Value of the Providence Medicare Advantage Plans and PHIP Partnership Medical • Lower cost shares, examples: ‒ Hospital, outpatient surgery, ambulance and ER • Lower out-of-pocket maximum • No cap on worldwide urgent and emergent coverage Pharmacy • No Part D deductible • No coverage gap/donut hole • No catastrophic coverage phase; the PHIP Rx plan has a true out-of-pocket maximum • A not-to-exceed per prescription cap of $250 for a month supply
Providence Medicare Advantage Plans Enrollment Service Area Oregon – Benton, Clackamas, Columbia, Crook, Deschutes, Hood River, Jefferson, Lane, Linn, Marion, Multnomah, Polk, Washington, Wheeler and Yamhill Washington – Clark
Providence Medicare Advantage Plan Options Both plans provide the same: Differences between the plans, • Covered services outside of the monthly premium: • Network of contracted providers • Amounts paid at time of service • Part D prescription drug program and overall out-of-pocket cost • How you access a service (in or out-of-network, with or without a referral) Features Align Group Flex Group Type of Plan HMO HMO-POS Monthly Premium Higher Premium Lower Premium Out-of-Pocket Costs Low Moderate Provider Access In-Plan Only In-Plan or Out-of-Plan Primary Care Physician Required Required Referral Requirement Referral Required Referral Optional
Providence Medicare Advantage Plan Options 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 $125 copay per day 20% $500 maximum per admit $500 max per admit 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 $6,350 per individual Maximum
Providence Health Assurance Pharmacy Formulary and Network Covers a broad list of medications • Formulary available online at ProvidenceHealthAssurance.com/PHIP Network Pharmacies* Pharmacies Walgreens Target • Over 34,000 participating pharmacies to choose from throughout the nation Fred Meyer Wal-Mart • Two types of contracted pharmacies: Safeway Rite Aid ‒ Network Pharmacies Costco Bi-Mart ‒ Preferred Network & Mail Order Pharmacies ▫ Deeper discounts, to help save you money ▫ Over 90% of our pharmacies are preferred *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.
Providence Medicare Advantage Plans Emergency and Travel Benefits Service Align Group Flex Group Urgent Care* $25 copay $25 copay (worldwide coverage) Emergency Room* $50 copay $65 copay (worldwide coverage) Ambulance* $50 copay $50 copay (worldwide, air or ground) $30 copay for a doctor Follow-up care Travel Benefit visit $1,000 allowance (nationwide, must use a $35 copay for a specialist Providence pays 80% Medicare Provider) visit Member pays 20% 20% for all other services *No coverage limit on emergency, urgent care or ambulance
Providence Medicare Advantage Plans Extra Benefits • No lifetime reserve days limit on hospitalization • Streamlined skilled nursing facility admission • $500 annual benefit for health and wellness classes • Annual routine vision exam covered – Align plan $15 copay – Flex plan $20 copay • $100 frame allowance once every 2 years • No-cost fitness center membership – For a list of contracted facilities visit Silverandfit.com
Providence Medicare Advantage Plans Extra Benefits TruHearing Benefit Includes: • Annual benefit • $45 copay hearing exam • Plan covers up to two hearing aids per year TruHearing Advanced TruHearing Pemium* 32 Channels | 6 programs 48 Channels | 6 Programs $699 copay per aid $999 Copay per aid *Rechargeable battery option is on select Premium aids for an additional $75 per aid • Three follow-up visits for fittings and adjustments at no additional cost • A worry-free purchase with a 45-day trial and 3-year warranty • 48 free batteries per aid included with non-rechargeable models
Providence Medicare Advantage Plans Special Attributes • Over 11,000 in-network providers and growing • Providers closed to Medicare; may be open to see you with a Providence Medicare Advantage Plan • No balance billing
Providence Medicare Advantage Plans Alternative Ways to Receive Care Providence Express Care Virtual • $0 Cost share on all plans • Video visit with a Providence care provider on a smartphone, tablet or computer • No appointment necessary • Available 7 days a week, 8 a.m. – midnight • virtual.providence.org Providence Express Care Clinics • Less expensive than urgent care ― Same cost as a PCP visit • Available 7 days a week, extended hours • To locate an Express Clinic, visit: providence.org/ourservices/expresscare/locations
Providence Medicare Advantage Plans Special Attributes Quality of service • Local customer service; based in Beaverton, Oregon • Dedicated service team for prospective members • Free Nurse Advice Line — available 24 hours a day, 7 days a week • Nurse Care Managers who personally assist with complex medical needs Online resources • Physician finder • Rx formulary • Detail about benefits • Value-added services and discounts • myProvidence • Mobile ID App • Visit providencehealthassurance.com/phip
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