Medicare Advantage Plans Providence 2025

Selecting the right Medicare Advantage plan in Providence can be crucial for your health and finances. This guide offers clear insights into Providence’s Medicare Advantage plans, detailing the types, benefits, and how to enroll in Medicare Advantage Plans Providence.

If you’re ready to find a compatible healthcare plan, read on for essential tips and streamlined information on making your coverage work for you.


Key Takeaways

  • Providence Medicare Advantage Plans provide comprehensive healthcare options with various plans such as HMO, HMO-POS, and HMO D-SNP, designed to meet diverse beneficiary needs and preferences, including prescription drugs, preventive screenings, and extra fitness benefits.


  • Members of Providence Medicare Advantage plans have seamless access to a vast network of primary care providers and specialists without the need for referrals, along with dedicated support teams, coverage for urgent care and emergency services, and a search tool to navigate network providers.


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Understanding Providence Medicare Advantage Plans


Medicare Advantage Plans Providence 2025, Understanding Providence Medicare Advantage Plans


Providence Health and Services, known for its commitment to compassionate care, brings a range of Providence Medicare Advantage Plans to the table. These plans are crafted to suit individual healthcare needs, ensuring that each beneficiary has access to the right mix of services and support.

From prescription drug coverage to essential preventive screenings, Providence’s health plans provide a complete list of comprehensive care options.


Types of Providence Medicare Advantage Plans

Diving into the specifics, Providence offers several types of Medicare Advantage plans, including HMO, HMO-POS, and HMO D-SNP plans, each tailored to different healthcare needs and preferences.

The Providence Medicare Align Group + Rx (HMO) plan, for example, strikes a balance with higher monthly premiums but lower out-of-pocket costs, necessitating the use of in-network providers and a primary care physician, with referrals for specialty services.

On the other hand, the Providence Medicare Flex Group + Rx (HMO-POS) offers lower monthly premiums with moderate out-of-pocket costs and the flexibility to use out-of-plan providers at times without referrals.

Those eligible for both Medicare and Medicaid might find the Providence Medicare Dual Plus (HMO D-SNP) plan most advantageous, with its $0 health plan premium and comprehensive dental services at no additional copays, subject to authorization requirements.

Additionally, a Medicare supplement plan can provide extra coverage for certain expenses not covered by original Medicare, which is the traditional fee-for-service program offered directly through the federal government.


Benefits and Features

The benefits of enrolling in a Providence Medicare Advantage plan are manifold. Some of the perks that come with these plans include:

  • $0 copay for Tier 1 preferred generic drugs


  • Access to the Medication Therapy Management program



  • Fitness benefits include access to thousands of gyms and virtual classes


  • A fitness tracker at no extra cost


These benefits provide members with a safety net for managing their prescription needs and promote overall health and wellness.

Vision and auditory care are also included at no cost, and members can opt for additional dental coverage upon application. For mental health services and tools to manage health as one ages, such as Connect America Medical Alert systems, Providence Medicare Advantage plans are more than just a safety net.

Navigating Providence’s Network for Medicare Advantage Plan Members


Medicare Advantage Plans Providence 2025, Navigating Providence's Network for Medicare Advantage Plan Members


Accessing healthcare services within the Providence network is a seamless experience for members of its Medicare Advantage plans. The network comprises thousands of healthcare providers, extending beyond those directly affiliated with Providence.

For those in need of alternative care such as chiropractic or acupuncture, which can be seen as expressions of god’s healing, American Specialty Health (ASH) is the contracted administrator within the Providence network to turn to.


Finding Primary Care Providers

When it comes to finding a primary care doctor, members are equipped with an easily navigable provider search tool available through Providence. This ensures coverage by connecting them with the vast array of in-network primary care providers.

While visits to these providers typically require only the specified plan copay, it’s important for members to confirm that their selected primary care providers are part of the Medicare Advantage network to ensure coverage.


Accessing Specialty Care

The path to specialized care is equally accessible. As of 2023, Providence Medicare Advantage plans in Hood River, Oregon have removed the need for referrals to visit in-network specialists, broadening the horizon for members to receive the care they need without additional steps.

This expansive network includes a range of specialists, not just those bearing the Providence name, and provides a dedicated support team to assist members with their healthcare needs. To make the most of our services, contact us.


Urgent Care and Emergency Services

In times of urgent medical need, members of Providence Medicare Advantage plans can rest assured that their coverage extends to urgent care and emergency services.

In-network urgent care centers are available to provide a range of services for non-life-threatening conditions, often at a lower cost than an emergency department visit.

While members may have coverage for out-of-network emergency care, utilizing in-network centers minimizes out-of-pocket costs and ensures immediate care for conditions such as minor lacerations or asthma.

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Enrollment Process for Providence Medicare Advantage Plans


Medicare Advantage Plans Providence 2025, Enrollment Process for Providence Medicare Advantage Plans


The journey to becoming a member of a Providence Medicare Advantage plan starts with the enrollment process. Eligible individuals can enroll during designated periods, and Providence offers several avenues for assistance, including the Medicare toll-free number and the official website.


Eligibility Requirements

Eligibility for Providence Medicare Advantage plans is straightforward: individuals must be enrolled in Medicare Part A and Part B and reside within the plan’s service area, which includes specific counties in Oregon, Washington, and parts of California.

There are also specific plans like the Dual Eligible Special Needs Plan, which cater to individuals holding both Medicare and Medicaid coverage. However, not all plans are designed to accommodate such unique circumstances.


Enrollment Periods

Enrollment periods serve as gateways for joining a Providence Medicare Advantage plan. New enrollees have a seven-month window around their 65th birthday, while the Annual Election Period from October 15 to December 7 each year allows for changes and new enrollments.

The Medicare Advantage Open Enrollment Period, from January 1 to March 31, offers another opportunity for existing members to make changes. Special Enrollment Periods, triggered by life events such as moving or losing coverage, provide additional enrollment flexibility.


Application Procedures

Once eligibility is confirmed, the application process involves filling out forms specific to the applicant’s county of residence and their chosen Providence Medicare Advantage plan.

Contract Renewal and Plan Updates


Medicare Advantage Plans Providence 2025, Contract Renewal and Plan Updates


Annual contract renewal is an essential aspect of maintaining your Providence Medicare Advantage plan. This process ensures that members continue to receive the benefits they’ve come to rely on.


Annual Contract Renewal

The contract renewal period aligns with the Medicare Annual Enrollment Period, during which members are informed about any changes to their plans for the upcoming year. This is done through the Annual Notice of Change, which is sent out by September 30th, and the Evidence of Coverage documents.


Staying Informed on Plan Changes

To keep abreast of any plan changes, members should:

  • Regularly check the Providence online portal


  • Review the Annual Notice of Changes


  • Attend informational meetings hosted by Providence to explain plan changes


  • Keep their contact information updated

Tips for Maximizing Your Providence Medicare Advantage Plan Experience


Medicare Advantage Plans Providence 2025, Tips for Maximizing Your Providence Medicare Advantage Plan Experience


To get the most out of your Providence Medicare Advantage plan, it’s important to take full advantage of the benefits and services available to you. This includes utilizing preventive services, managing medication side effects, and accessing resources for optimal aging.


Preventative Care

Preventive care is at the heart of Providence Medicare Advantage plans, with services like oral exams, cleanings, and fluoride treatments available with $0 copays. This emphasis on regular preventive care is a cornerstone for maintaining optimal health.


Managing Medication Side Effects

Medication side effects can be managed effectively with the support of Providence’s dedicated behavioral health teams. These teams are available 24/7 to assist members in navigating any challenges they may face with their medications.


Accessing Resources for Optimal Aging

Resources for optimal aging, such as the Optum One Pass® Fitness Program, health coaching, and wellness classes, are integral parts of the Providence Medicare Advantage plan offerings.

These resources aim to promote a balanced lifestyle, which is essential for healthy aging and embodying compassion, dignity, justice excellence.


Providence Medicare Advantage Plans stand as a testament to a healthcare system that goes beyond basic medical needs, offering a spectrum of services that cater to preventive care, wellness, and the management of chronic conditions.

As you consider your options for 2025, remember that these plans are more than just insurance; they are a comprehensive approach to health and well-being. By staying informed and proactive, you can maximize the benefits offered by Providence and continue to lead a healthy, fulfilling life.


Frequently Asked Questions


  Do I still pay Medicare premiums with an Advantage plan?

Yes, you still need to pay Medicare Part B premiums with a Medicare Advantage plan, in addition to any monthly premium for the Advantage Plan. The standard Part B premium amount is $174.70 in 2025.


  What is the average Medicare Advantage premium for 2025?

The average Medicare Advantage premium for 2025 is $15 per month, with some plans costing nothing and others up to $100 or more, and 73% of enrollees having no premium. Different plan types have varying average premiums, ranging from $14 to $46 per month.


  Who is the largest provider of Medicare Advantage plans?

The largest provider of Medicare Advantage plans is UnitedHealth Group, with 7.6 million people in its plans.


→  What is the most highly rated Medicare Advantage plan?

Humana has led the industry in the percentage of members in highly rated Medicare Advantage plans for the last six years, with nearly 5.5 million members enrolled in 4-star and above plans for 2025.


 What types of Medicare Advantage plans does Providence offer?

Providence offers HMO, HMO-POS, and HMO D-SNP plans to cater to various healthcare needs and preferences.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.