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2010 Providence Medicare Advantage Plans Comparison
This is only a brief comparison of benefits. For a complete Summary of Benefits, including premium and plan guidelines, please refer to the pre-enrollment packet provided by Providence Medicare Advantage Plans. Medicare coverage rules apply to the benefits listed below, for instance, you must continue to pay your Medicare Part B premium.
| With Prescription Drug Benefit |
Without Prescription Drug Benefit |
||
|---|---|---|---|
| Note: Your must continue to pay your Medicare Part B premium. | |||
| Providence Medicare Extra + RX (HMO) |
Providence Medicare Choice + RX (HMOPOS) |
Providence Medicare Extra (HMO) |
Providence Medicare Choice (HMOPOS) |
| $117 | $58 | $92 | $32 |
| Providence Medicare Extra* (HMO) | Providence Medicare Choice (HMOPOS) | ||
|---|---|---|---|
| In-network benefit only | In-network | Out-of-network | |
| (A) Diagnostic testing copayment may apply. (B) Copayment waived if admitted within 24 hours for the same condition. (C) For office visits, other charges may apply. (D) Separate office visit copay may apply. *You must use plan providers except in emergent or urgent care situations (or for out-of-area renal dialysis). If you obtain routine care from out-of-network providers neither Medicare nor Providence Medicare Advantage Plans will be responsible for the costs. |
|||
| You Pay | You Pay | ||
| Doctor Office Visit | $15 | $20 | $30 |
| Specialist Visit (Referral needed for PME and PMC In-Network providers) |
$15 | $20 | $30 |
| Lab | $0 | $0 | 20% |
| Xray | 10% | 10% | 20% |
| Outpatient Surgery | $100 | $150 | 20% |
| Routine Eye Exam Every 24 months (A) (no referral needed) | $15 | $20 | $30 (C) |
| Medical Eye Exam | $15 | $20 | $30 (C) |
| Annual Women’s Exam Pap, Pelvic, Mammogram (no referral needed) | $15 (A) | $20 (A) | 20% (D) |
| Mental Health & Chemical Dependency Counseling | $15 | $20 | 20% |
| Therapy: PT, OT, ST | $15 | $20 | 20% |
| Inpatient Hospital | $300 | $450 | 20% |
| Skilled Nursing Facility Day 1-20 Day 21-100 |
$0 $0 |
$0 $50/day |
20% 20% |
| Home Health Care | $0 | 10% | 20% |
| Durable Medical Equipment | 10% | 15% | 20% |
| Test strips and glucometers | $0 | $0 | 20% |
| Emergency Room (A) (World-wide Coverage) |
$50 (B) | $50 (B) | $50 (B) |
| Urgent Care (A) (World-wide Coverage) |
$25 (B) | $25 (B) | $25 (B) |
| Ambulance (World-wide) (Air or Ground) |
$100 | $100 | $100 |
| Out-of-pocket Maximum | $2,500 | $3,400 | |
| Initial Coverage | Coverage Gap | Catastrophic Coverage |
|---|---|---|
| Phase 1† Benefit Eligible |
Phase 2 No Benefit |
Phase 3‡ Benefits Restart, but at a different level |
| †72% of our members stay in Phase 1 | ‡4% of our members reach Phase 3 | |
| You Pay | You Pay | You Pay |
| $0 deductible $6 Generic drugs $45 Brand name drugs 33% Specialty drugs When the total paid by you and the plan reaches $2,830 Phase 2 begins |
All costs until you
have paid $4,550
out-of-pocket After that Phase 3 begins |
$0 deductible $2.50 Generic drugs $6.30 or 5% whichever is greater for Brand name and Specialty drugs |
*The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage.
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