Providence Medicare Dual Plus (HMO D-SNP)
Health Insurance Company: Providence Medicare Advantage Plans
Medicare Advantage Plan Details
Medicare-Medicaid Dual Eligible (D-SNP)
- Rx
- Dental
- Vision
- Hearing
General Plan Details
Additional Benefits
Doctor & Hospital Coverage
Emergency Room
0% or 20% coinsurance per visit (always covered)
Ambulance Coverage
0% or 20% coinsurance
Lab, X-Ray, Radiology Coverage
Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: 0% or 20% coinsurance
Medicare-covered lab services: $0 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): 0% or 20% coinsurance
Medicare-covered x-ray services: 0% or 20% coinsurance
Outpatient Surgery Coverage
Outpatient hospital:
Medicare-covered outpatient hospital services: 0% or 20% coinsurance per visit
Hospitalization Coverage
Inpatient hospital-acute:
In 2024 the amounts for each benefit period are $0 or:
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Inpatient hospital psychiatric:
In 2024 the amounts for each benefit period are $0 or:
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Rehabilitation Coverage
Occupational therapy services:
0% or 20% coinsurance
Physical therapy and speech and language therapy services:
0% or 20% coinsurance
Urgent Care Coverage
0% or 20% coinsurance per visit (always covered)
Skilled Nursing Facility (SNF)
In 2024 the amounts for each benefit period are $0 or:
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100
Mental Health Coverage
Medicare-covered individual sessions: 0% or 20% coinsurance
Medicare-covered group sessions: 0% or 20% coinsurance
Dental, Vision, Hearing Benefits
Dental Services
Oral exams: $0 copay
Prophylaxis (cleaning): $0 copay
Dental x-rays: $0 copay
Vision Benefits
Eye exams:
Routine eye exams: $0 copay
Eyewear:
Contact Lenses: $0 copay
Eyeglasses: $0 copay
Hearing Benefits
Hearing exams:
Routine hearing exams: 0% or 20% coinsurance
Plan Links
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