v Providence Health Assurance
Providence Medicare Advantage Plans 2019 Plan Year Changes Medicare - Align Group Plan + Rx (HMO) • The Prescription Drug out-of-pocket maximum per person per calendar year is $5,100 Medicare – Flex Group Plan + Rx (HMO-POS) • The Prescription Drug out-of-pocket maximum per person per calendar year is $5,100 Non-Medicare • The Core Value and Select Value plans are no longer available
Providence Health Assurance Medicare Advantage Plans
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 • Benefit stability 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 cape 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 County
Providence Medicare Advantage Plan Options Both plans provide the same: Differences between the plans, outside of • the monthly premium: Covered services • • Amounts paid at time of service and Network of contracted providers overall out-of-pocket cost • Part D prescription drug program • 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 $5,100 per individual Maximum
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) Travel Benefit Follow-up Care $30 copay for a doctor visit (Nationwide, must use a $1,000 allowance Providence $35 copay for a specialist visit Medicare Provider) pays 80% Member pays 20% 20% for all other services *No coverage limit on Emergency, Urgent Care or Ambulance
Providence Medicare Advantage Plans Extra Benefits • Care Management Assistance • Annual Routine vision exam covered ‒ Align plan $15 copay • No lifetime reserve days limit on ‒ Flex plan $20 copay hospitalization • $100 frame allowance once every 2 • Streamlined skilled nursing facility years admission • No-cost fitness center membership • $500 annual benefit for health and ‒ For a list of contracted facilities wellness classes visit www.silverandfit.com
Providence Medicare Advantage Plans Special Attributes 5 Star plan • Our Medicare plans for 2018 received Medicare’s highest possible rating, 5 out of 5 stars • 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 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 • Benefit specific detail • Value added services and discounts • myProvidence • Mobile ID App • Visit www.providencehealthassurance.com/phip
Providence Medicare Advantage Plans Extra Benefits 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 8am to Midnight, 7 days a week • virtual.providence.org Providence Express Care Clinics • Less expensive than urgent care - Same cost as a PCP visit • Available from 8am to 8pm or 7am to 7pm seven days a week • To locate an Express Clinic, visit: https://www.providence.org/our-services/expresscare/locations
Providence Health Assurance Part D Prescription Drug Plan
Pharmacy Network Benefit Providence PHIP Formulary • Covers a broad list of medications – Formulary available online at www.ProvidenceHealthAssurance.com/PHIP Included Medication Therapy Management (MTM) • MTM services are associated with improved medication use, lower drug costs, improved disease management, reduced hospitalizations and reduced hospital readmissions • Free service for our Medicare members Pharmacies • Over 34,000 participating pharmacies to choose from throughout the nation Examples of Preferred • Two types of contracted pharmacies: Network Pharmacies* ‒ work Pharmacies Walgreens Target ‒ Preferred Network & Mail Order Pharmacies Fred Meyer Wal-Mart ▫ Deeper discounts, to help save you money Safeway Rite Aid ▫ Over 90% of our pharmacies are preferred 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.
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