Providence Medicare Advantage Plans Review

Providence Health Plans is a non-profit, faith-based company that has its roots in a network of hospitals, schools, and orphanages established by the Sisters of Providence in the Pacific Northwest. Providence’s Medicare Advantage Plans are underwritten by Providence Health Assurance Company and serve Medicare beneficiaries in some Oregon and southwest Washington counties.

All of Providence’s Medicare Advantage Plans are HMOs, including HMO-POS and D-SNPs. Plans offer extra benefits and may include prescription drug coverage. Plan options vary depending on your county of residence.

Providence is a smaller company compared to other Medicare Advantage insurers in the country and is not rated by all reviewing entities for financial or consumer performance. However, all of Providence’s plans earned the highest rating of five stars from the Centers for Medicare and Medicaid Services (CMS).

Providence Medicare Advantage Plans are comparable in their scope of coverage to other Medicare Advantage Plans, offering all the benefits of Original Medicare, along with coverage for additional health services. Medicare Advantage Plans, also called Medicare Part C, often include prescription drugs, vision and dental coverage, and wellness programs. Your out-of-pocket costs depend on the plan you choose, as do rules for how you get services, such as whether you have to choose a primary care doctor or get a referral to see a specialist.

Your hospital and medical insurance benefits are covered, and you’ll get prescription drug coverage as well with most plans. Additional benefits from Providence Medicare Advantage Plans may include:

• Dental
• Vision
• Hearing
• Silver&Fit membership
• ProvRN (24/7 phone support)
• ExpressCare Virtual
• ExpressCare Clinic
• Worldwide emergency
• Over-the-counter drugs

Providence offers only Health Maintenance Organization (HMO) plans which pay for health benefits from a specific network of providers. Within these HMOs, Providence has a standard HMO option, a Point of Service option, and a Dual-eligible Special Needs Plan. Dual-eligible plans are specifically for those eligible for both Medicare and Medicaid. Point of Service HMOs allow you to go out of network for certain services, but it may cost you more.

Compare these 2022 Providence Medicare Advantage Plans with drug coverage in Clackamas County, Oregon:

Providence’s Medicare Advantage Plans are favorably rated by Medicare and NCQA. Other reviewing entities do not rank or rate Providence’s plans. If you live in the Pacific Northwest and have access to a Providence Medicare Advantage Plan, speak with your providers or licensed Medicare agent about their experience with Providence.

Is Providence the best Medicare Advantage Plan provider? See how this insurer compares on major ratings.

Ask these questions as you consider whether a Providence Medicare Advantage Plan is right for you:

• Is your doctor covered?
• Are your prescriptions covered?
• What’s your monthly premium?
• What are your out-of-pocket costs?
• What additional benefits does the plan offer?

You can enroll in a Medicare Advantage Plan if you’re enrolled in Original Medicare. Enrollment is available during these periods:

• Your Initial Enrollment Period: Seven months around and at your 65th birthday when you’re newly eligible for Medicare.
• Open Enrollment Period: Annually between October 15 and December 7.
• Medicare Open Enrollment: Annually between January 1 and March 31, but only if you’re already enrolled in a Medicare Advantage Plan and want to make a change