Providence Health offers a variety of Medicare Advantage plans in Washington and Oregon. Providence also offers Special Needs Plans for eligible individuals.
If you live in certain parts of Oregon or Washington, Providence has a range of Medicare Advantage (Part C) health insurance plans, including HMO and HMO-POS plans.
Providence Advantage plans provide the same coverage as Original Medicare (parts A and B), plus some additional benefits to round out your healthcare coverage.
This article looks at the types of Medicare Advantage plans that are available, the services they cover, and how much they cost.
Providence offers several types of Medicare Advantage plans throughout its service areas.
Providence HMO plans
Providence offers a variety of HMO (Health Maintenance Organization) plans. Like all Medicare Advantage plans, these products provide all the same benefits as Original Medicare (parts A and B), plus extra healthcare services like vision and dental coverage.
Some plans include coverage of alternative healthcare services, such as chiropractic and acupuncture services, but annual limits may apply.
In an HMO, you need to choose your doctors from the plan’s in-network provider directory. You’ll generally see a primary care physician (PCP) for most of your care. From time to time, your PCP may give you a referral to a specialist when needed.
Your plan will not cover medical services you receive from out-of-network healthcare providers unless it’s an emergency.
Providence HMO-POS plans
Providence offers a limited number of HMO Point-of-Service (HMO-POS) plans that allow you to get certain covered services from out-of-network providers.
However, your copays will probably be higher when you see these providers. The out-of-network provider must also agree in advance to accept your health insurance plan.
Providence HMO D-SNPs
Providence offers Medicare Advantage HMO Dual Eligible Special Needs Plans (D-SNPs) in Clackamas, Multnomah, and Washington counties in Oregon. These plans are only available to people who are eligible for both Medicare and Medicaid.
Dual Plus HMO D-SNP plans have no premiums, deductibles, or copays. They offer several important benefits, such as:
- telehealth
- urgent care services
- no cost or low cost prescription drugs
- preventive dental care
- routine eye exams and glasses
Most Providence Medicare Advantage plans offer prescription drug coverage (Medicare Part D). These plans require you to use one of the 34,500 in-network pharmacy locations nationwide.
However, there are exceptions when traveling, in emergencies, and for times when your medication is out of stock at your normal pharmacy.
Providence maintains a list of covered medications, called a formulary. The cost and restrictions for the listed drugs can change over time. You will usually be notified about any changes 60 days in advance.
Providence offers Medicare Advantage plans in Washington and Oregon.
In Washington, Providence covers the following counties:
- Clark
- Snohomish
- Spokane
In Oregon, Providence covers these counties:
- Benton
- Clackamas
- Columbia
- Crook
- Deschutes
- Hood River
- Jefferson
- Lane
- Linn
- Marion
- Multnomah
- Polk
- Washington
- Wheeler Yamhill
Compare Providence Medicare Advantage plans in your area
Medicare Advantage plans vary by county or city. You can use this online tool to search and compare Providence plans in your area.
Many Providence Medicare Advantage plans offer:
- preventive medical and dental care
- free fitness center memberships
- access to Express Care Virtual on-demand telehealth services
- routine vision and hearing care
- optional dental plans
Premiums, deductibles, out-of-pocket limits, copays, and coinsurance rates vary widely from plan to plan. Research these details carefully as you consider which plan will best fit your coverage and financial needs.
Here are some examples of 2025 costs for Providence Medicare Advantage plans in different coverage areas:
| Location | Plan | Monthly premium | Health deductible, drug deductible | Out-of-pocket max |
|---|---|---|---|---|
| Oregon counties: • Clackamas • Multnomah • Washington • Yamhill | Providence Medicare Prime + Rx (HMO) | $0 | • Health: $0 • Drug: $250 (waived on tier 1 and tier 2 drugs) | $5,000 |
| Benton and Linn counties in Oregon | Providence Medicare Extra + Rx (HMO) | $161 | • Health: $0 • Drug: $0 | $4,000 |
| Oregon counties: • Crook • Deschutes • Hood River • Jefferson • Wheeler | Providence Medicare Choice + Rx (HMO-POS) | $82 | • Health: $0 • Drug: $0 | $5,000 |
| Oregon counties: • Columbia • Lane • Marion • Polk Clark County in Washington | Providence Medicare Timber + Rx (HMO) | $0 | • Health: $0 • Drug: $250 (waived on tier 1 and tier 2 drugs) | $6,000 |
| Snohomish County in Washington | Providence Medicare Cottonwood + Rx (HMO-POS) | $37 | • Health: $0, • Drug: $0 | $5,500 |
| Spokane County in Washington | Providence Medicare Pine + Rx (HMO) | $0 | • Health: $0 • Drug: $195 (waived on tier 1 and 2 drugs) | $6,000 |
Medicare Advantage (Part C) is a type of health insurance plan offered by private insurance companies. They are required to provide the same coverage as Original Medicare (Part A and Part B), plus a variety of extra benefits that vary according to the specific plan.
Because Medicare Advantage plans are private insurance plans, not every company offers coverage in every state. To compare plans in your area, you can use Medicare’s plan finder tool.
Providence offers a variety of Medicare Advantage plans in Oregon and Washington. Most of the plans are HMOs, but Providence does offer a few HMO-POS plans that offer more choices. HMO-POS plans may come with higher copays and more cost-sharing for members.
Providence also offers an HMO D-SNP program for people who are eligible for both Medicare and Medicaid. Most of the plans include prescription drug coverage.
Costs, benefits, and provider networks vary from plan to plan, so you may want to use Medicare’s plan finder tool to explore each plan and find the ones that might work for you.