- What do Providence Medicare Advantage Plans cover?
- What are Providence’s Medicare Advantage Plan options?
- Pros and cons of Providence Medicare Advantage plans
- Providence Medicare Advantage Plans reviews and ratings
- How Providence Medicare Advantage Plans compare
- How to choose a Medicare Advantage Plan
- When can you enroll in a Providence Medicare Advantage Plan?
Providence Medicare Advantage Plans Review
Fact checked Reviewed by: Leron Moore, Medicare consultant - Updated: Jan 13, 2022
Is a Providence Medicare Advantage Plan a good fit for you?
Providence offers a selection of Medicare Advantage HMO plans in parts of Oregon and Washington.
|Medicare rating: 5 stars||A.M. Best financial strength rating: Not Rated||BBB rating: (Providence Health Plan: F) Medicare Advantage: Not Rated||NCQA rating: 4 stars||Consumer Affairs rating: Not Rated||J.D. Power ranking: Not Ranked|
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).
What do Providence Medicare Advantage Plans cover?
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:
- Silver&Fit membership
- ProvRN (24/7 phone support)
- ExpressCare Virtual
- ExpressCare Clinic
- Worldwide emergency
- Over-the-counter drugs
What are Providence’s Medicare Advantage Plan options?
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 Medicare Advantage Plans|
|Plan name||Monthly premium*||Annual deductible||Office visits||Annual maximum out-of-pocket cost|
|Providence Medicare Prime + RX (HMO)||$0$170.10 std Part B prem||$0 (health) $150 (drug)||$0 primary /$40 specialist||$5,900 in network|
|Providence Medicare Bridge 1 + RX (HMO-POS)||$35$170.10 std Part B prem||$0 (health)$0 (drug)||$0 primary / $35 specialist||$4,900 in network $10,000 in and out of network combined|
|Providence Medicare Dual Plus (HMO D-SNP)||$40.50$170.10 std Part B prem||$0 or 233 (health)$480 (drug)||0% or 20% coinsurance for primary and specialist||$3,400 in network|
*Based on pricing in Clackamas County, Oregon
**Dual access SNP for Medicare and Medicaid eligible, may get financial assistance for Part B premiums, deductibles, and drug costs.
Pros and cons of Providence Medicare Advantage plans
What we like about Providence Medicare Advantage Plans:
The drawbacks of Providence Medicare Advantage Plans:
Providence Medicare Advantage Plans reviews and ratings
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.
|Medicare rating: 5 stars||Providence’s Medicare Advantage Plans have an overall quality rating of 5 stars, the highest rating possible, from the Centers for Medicare & Medicaid Services.|
|A.M. Best financial strength rating: Not Rated||A.M. Best sets credit ratings for insurers. Providence Health Plans are not rated by A.M. Best.|
|BBB rating: F (Medicare Advantage Plans not rated)||Providence Health Plans offer commercial insurance. Providence Assurance Plans include Medicare plans, which are not rated by the BBB.
The BBB gives Providence Health Plan an F rating, with three complaints closed in the past year and eight complaints closed in the past three years. The reason cited for the poor rating is failure to respond to five out of eight complaints.
|NCQA rating: 4 stars||Providence Health Assurance plans, the underwriters of Providence’s Medicare Advantage Plans, received a 4 out of 5 star rating by the National Committee for Quality Insurance (NCQA), a leading accreditation agency.|
|Consumer Affairs rating: Not Rated||Providence is not rated by Consumer Affairs.|
|J.D. Power ranking: Not Ranked||Providence is not ranked in the top ten by J.D. Power.|
How Providence Medicare Advantage Plans compare
Is Providence the best Medicare Advantage Plan provider? See how this insurer compares on major ratings.
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|Aetna||4 stars||A||A+||2.5 to 4.5 stars||Fifth out of 10|
|Anthem Blue Cross Blue Shield||4 to 4.5 stars||A+||A+||Not rated||Sixth out of 10|
|Cigna||4 stars||A-||Not rated||2.5 to 4.5 stars||Seventh out of 10|
|Highmark||4.5 stars||A||A-||2.5 to 4.5 stars||Second out of 10|
|Humana||4 stars||A-||A+||1.5 to 4.5 stars||Third out of 10|
|Kaiser||5||A||A-||4.5 to 5 stars||First out of 10|
|Premera||3.5 to 4.5 stars||A||B-||3 stars||Not ranked|
|Providence||5 stars||Not rated||F||4 stars||Not ranked|
|UnitedHealthcare||3.5 stars||A-||A-||4 stars||Fourth out of 10|
How to choose a Medicare Advantage Plan
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?
When can you enroll in a Providence Medicare Advantage Plan?
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
- Featured Sources [-]
Better Business Bureau | Providence Health Plans | Last Accessed January 2022
Medicare: How Do Medicare Advantage Plans Work? | Last Accessed January 2022
Medicare: Health Maintenance Organizations | Last Accessed January 2022
Medicare: Find a 2022 Medicare Plan | Last Accessed January 2022
NCQA: NCQA Health Insurance Plan Ratings 2019-2020 – Summary Report | Last Accessed January 2022
Providence Health Plans | History of the Company | Last Accessed January 2022
Providence Health Plans | Medicare Advantage Plans | Last Accessed January 2022
Leron Moore, Medicare consultant
Leron Moore has guided Medicare beneficiaries and their families as a Medicare professional for nearly 15 years. First as a Medicare provider enrollment specialist, and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.