Plan Details

Providence Medicare Focus Medical (HMO)

Overview

Monthly Premium

$120

Annual Deductible

$0

Maximum Out-of-Pocket

$4,200 In-network

Additional Benefits
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$0 copay for preventive dental

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$250 eyeware allowance and eye exam

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Copays for hearing aids + $0 exams

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$100 every 6 months for OTC items

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Gym membership

Extra Help

Extra Help, also known as a Part D Low-Income Subsidy, or LIS, is a federal program that helps lower prescription costs and Part D (prescription) costs for Medicare Advantage members. Learn more about Extra Help by connecting with one of our team members who can help walk you through how the program works.

Learn more

Provider Network

Search the integrated network to find in-network providers or pharmacies. When searching, please select your plan as your provider network.

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Important information about this plan

This plan is available in Clackamas, Hood River, Lane, Multnomah, Washington and Yamhill Counties in Oregon and Clark County in Washington.

Does not include any Part B premium you may have to pay. You must continue to pay your Medicare Part B premium.



For more information about Providence Medicare Advantage Plans, please contact the sales team.

This information is available in a different format, including audio CDs. If you need plan information in another format, please call Customer Service at 503-574-8000 or 1-800-603-2340 (TTY: 711). Service is available between 8 a.m. to 8 p.m. (Pacific Time) 7 days a week from October 1st through March 31st and Monday - Friday, from April 1st through September 30th.

Important note about these benefits

Our plan members get all the benefits covered by Original Medicare, plus some extras for being a Providence Medicare Advantage Plans member.

Benefit Summary

  • Benefits
    In-network
    Inpatient Hospital Coverage1$250 copay each day for days 1-5
    $0 copay each day for day 6 and beyond
    Outpatient Hospital Coverage1$250 copay for outpatient surgery at a hospital facility
    Ambulatory Surgery Center1$200 copay for outpatient surgery at an Ambulatory Surgery Center
    Primary Care Provider visit$0 copay
    Specialist visit$20 copay
    Preventive Care$0 copay
    Emergency Care$130 copay
    If you are admitted to the hospital within 24 hours, you do not have to pay your copay for emergency care.
    Urgently Needed Services$25 copay
    If you are admitted to the hospital within 24 hours, you do not have to pay your copay for urgent care.
  • Diagnostic Services + Labs & Imaging1
    In-network
    Diagnostic radiology services (e.g. MRI, ultrasounds, CT Scans)15% of the total cost up to $250 per day
    Therapeutic radiology services15% of the total cost
    Outpatient x-rays$0 copay
    Diagnostic test and procedures20% of the total cost
    Lab services$0 copay
  • Hearing Services
    In-network
    Medicare-covered$20 copay
    Routine exam$0 copay
    Hearing Aids$499 copay per hearing aid - Standard
    $699 copay per hearing aid - Advanced
    $999 copay per hearing aid - Premium
  • Dental Services
    In-network
    Medicare-covered$20 copay
    Embedded Preventive$0 copay includes exams, cleanings, X-rays, fluoride treatment. Limits apply.
    OptionalCovered for additional premium. Click for more details.
  • Vision Services
    In-network
    Medicare-covered$20 copay
    $0 copay for glaucoma screening
    Routine examThere is no coinsurance or copayment for one routine vision exam (including refraction) per calendar year
    Medicare-Covered Eyewear$0 copay for one pair of Medicare-covered eyeglasses or contact lenses after each cataract surgery
    Routine eyeglasses or contact lensesAllowance of up to $250 per calendar year for any combination of routine prescription eyewear
  • Mental Health Services1
    In-network
    Inpatient visit$200 copay each day for days 1-7
    $0 copay for days 8-90
    Outpatient individual and group therapy visit$20 copay
  • Skilled Nursing Facility1
    In-network
    Skilled Nursing Facility$0 copayment for days 1-20
    $218 copayment each day for days 21-100
  • Physical Therapy1
    In-network
    Physical Therapy$20 copay
  • Ambulance1
    In-network
    Ambulance$275 copay
  • Medicare Part B Drugs1
    In-network
    Medicare Part B Drugs0% - 20% of the total cost
    (Insulin cost share up to $35 per month)
  • Alternative Care1
    In-network
    Alternative CareMedicare covered chiropractic: $20 copay
    Medicare covered acupuncture: $20 copay
  • Meal Delivery Program
    In-network
    Meal Delivery Program
    (post-discharge only)
    $0 copay for 2 meals per day for 14 days, following a qualifying inpatient hospitalization
  • Over-the-Counter Items
    In-network
    Over-the-Counter Items$100 allowance every 6 months (retail card, catalog, online, mail, and telephonic ordering)
  • Personal Emergency Response System
    In-network
    Personal Emergency Response System (PERS)$0 copay
  • Fitness Program
    In-network
    Fitness Program$0 copay for monthly gym memberships with participating fitness clubs
  • Wig
    In-network
    WigThere is no coinsurance or copayment for one wig due to hair loss from chemotherapy.
1Services may require prior authorization.
Page current as of: 10/1/2025

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