Our 2022 plans
Our plans are accepted by thousands of doctors. We offer two Medicare Advantage Plan types, Providence Medicare Align Group Plan + Rx (HMO) and Providence Medicare Flex Group Plan + Rx (HMO-POS).PHIP Enrollment
PHIP plans offer more enhanced benefits than Providence Medicare Advantage Plans sold directly to non-PERS members.Compare our plans
2022 Benefit information
Providence Medicare Align Group Plan + Rx (HMO)
Providence Medicare Flex Group Plan + Rx (HMO-POS)
Contact PERS directly at 503-224-7377 or toll free 1-800-768-7377 for premium and enrollment information.
Individuals must have both Part A and Part B to enroll. You must continue to pay your Medicare Part B premium.
Members of Providence Medicare Align Group Plan + Rx (HMO) must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor Providence Medicare Advantage Plans will be responsible for the costs.
It may cost Providence Medicare Flex Group Plan + Rx (HMO-POS) members more to get care from out-of-network providers, except in an emergency or urgent care situation.
- Request to have a printed Evidence of Coverage document mailed to your home
- Request to have a printed Provider and Pharmacy Directory mailed to your home
- Request to have a printed Prescription Drug Formulary mailed to your home
- Medical Appeals, Determination and Grievance Processes
- Plan star rating (PDF)
- Travel benefit summary (PDF)
- PHIP handbook
- Contract information (PDF) This notice states that Providence Medicare Advantage Plans and/or CMS may choose to terminate their contract with each other at any time in the future.
- Privacy Notice
For more information about Providence Medicare Advantage Plans, you may contact the sales team at 503-574-8000 or toll free 1-800-603-2340 (TTY: 711), 8 a.m. to 8 p.m. (Pacific Time), seven days a week.
Few things in life are as precious to us as our health. We know that before you trust your health care coverage to Providence Medicare Advantage Plans you want to know that we'll be here for you when you need us. These questions and answers explain Providence Medicare Advantage Plans and should help put your mind at ease.
Explore the following topics to put your mind at ease
When does Medicare coverage start?
Medicare coverage starts on your Medicare effective date. Your effective date is the first of the month in which you turn 65, unless your birthday is on the first of the month. If your 65th birthday is on the first of the month, Medicare will start on the first of the month that precedes your 65th birthday. For example:
- If you turn 65 on Aug. 15, your Medicare effective date will be Aug. 1.
- If you turn 65 on Aug. 1, your Medicare effective date will be July 1.
What are Medicare Parts A and B?
Medicare Part A provides coverage for inpatient services, such as a hospitalization or a stay in a skilled nursing facility.
Medicare Part B provides coverage for outpatient services, such as a visit to the doctor, lab work or emergency room care.
How do I enroll in Medicare Parts A and B?
- If you collect Social Security at or before age 65, the Social Security Department will automatically enroll you in Medicare Parts A and B. You should receive your Medicare card from the Social Security Administration about three months before your 65th birthday.
- If you are celebrating your 65th birthday and are not collecting Social Security, or if you are losing group coverage, then you need to contact the Social Security office, www.ssa.gov or 1-800-772-1213, to enroll in Medicare Parts A and B.
Who is eligible?
You can enroll in a Providence Medicare Advantage plan if:
- You are entitled to Medicare Part A (hospital coverage) and enrolled in Medicare Part B (medical coverage);
- You live in a county where Providence Medicare Advantage Plans are offered
If you obtain routine care from out-of-network providers neither Medicare nor Providence Medicare Advantage Plans will be responsible for the costs except in emergency or urgent care situations or for out-of-area renal dialysis. Some exceptions apply to members of Providence Medicare Flex + RX (HMO-POS) who choose to use their point-of-service benefit. Please contact plan for details or refer to the Summary of Benefits for your plan.
Members may enroll in a plan only during specific times of the year. Contact customer service for more information.
Providence Health Assurance's contract with CMS is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed.
Do I get to pick my own doctor?
Absolutely. To help you get the health care you need, we ask that you build a relationship with one doctor who you feel comfortable with, a doctor you trust, a doctor who can get to know you and your health history.
We call this doctor your "primary care provider." To find out whether your current doctor is part of the Providence team, please view our provider directory, or call customer service at 503-574-5000, or 1-800-603-2340, TTY:711 (for the hearing impaired).
I have insurance through my employer or my spouse's employer, do I need to enroll in Medicare Part B?
It depends. If you are covered on a retirement group plan, you probably need to enroll in Medicare Parts A and B. However, if you or your spouse is actively employed or are covered under group coverage, consider the size of the employer in determining whether or not to waive your Medicare Part B.
- If the employer is small (fewer than 20 employees), it may be in your best interest to enroll in Medicare Part B. Your employer assumes that you have enrolled; and if you don't have Part B, you will pay for the services that Part B would have covered. For example, if you see a physician and are charged $100, and your employer group's plan covers $20, you will owe $80 if you haven't signed up for Part B.
- If the employer is large (20 or more employees), ask questions to understand whether and how your employer's plan covers Part B services, and whether the plan is considered creditable coverage. "Creditable" means that the plan pays as much as or more than Part B would pay. If you don't have creditable coverage and you sign up for Part B after your initial election period, you will owe a penalty.
What happens after I join?
- We will send you your member ID and member guide. Please read these materials when you get them.
- Call us if you have special needs; we'd be glad to accommodate you.
- Note: This is only an overview of benefits from Providence Medicare Advantage plans. Please see the summary of benefits for more information or the member handbook/evidence of coverage for a complete explanation of benefits, limits, and exclusions.
- If you have other questions, please contact the Providence Medicare Advantage Plans sales team locally at 503-574-8403 or toll free at 1-855-210-1587. We are open Oct. 1 through Mar. 31, seven days a week, 8 a.m. to 8 p.m. (Pacific Time), and Apr. 1 through Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. (Pacific Time).
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.