Providence Medicare Focus Medical (HMO)

Oregon Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$140
by Providence Medicare Advantage Plans

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Name
Providence Medicare Focus Medical (HMO)
Insurance Carrier
Providence Medicare Advantage Plans
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
HMO

Providence Medicare Focus Medical (HMO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Oregon and offered by the health insurance company Providence Medicare Advantage Plans. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$140
Annual Deductible
$0
Max Out-of-Pocket
$3,800
Primary doctor visit
$0 copay
Specialist visit
$20 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$50-275 copay

Providence Medicare Focus Medical (HMO) has a monthly premium cost of $140 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,800 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Providence Medicare Focus Medical (HMO) are defined below.

No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Providence Medicare Focus Medical (HMO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Providence Medicare Focus Medical (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Providence Medicare Focus Medical (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Providence Medicare Focus Medical (HMO) received an overall government quality rating of 4.0 stars out of 5 stars.

Providence Medicare Focus Medical (HMO) performed better than Oregon’s State average overall quality score of 3.5 stars.

This Plan’s 5-star Gov’t Quality Score
Oregon State Average Score
Overall Government 5 Star Quality Rating
 4.0
 3.5
Summary rating of health plan quality
 4
 3.4
Staying healthy: screenings, tests, & vaccines
 4
 3.7
Managing chronic (long term) conditions
 4
 3.2
Member experience with health plan
 3
 2.8
Member complaints & changes in the health plan's performance
 5
 4.0
Health plan customer service
 4
 3.8

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Providence Medicare Focus Medical (HMO) received 4 stars for its health plan quality score which is better than the Oregon State average health plan quality score of 3.4 stars.


Monthly Premium
$140
Health Portion of Premium
$140
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$3,800 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$20 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
20% coinsurance
Lab services
$0 copay
Diagnostic radiology services (like MRI)
15% coinsurance
Outpatient x-rays
$0 copay
Emergency care
$125 copay per visit (always covered)
Urgent care
$25 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$250 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Outpatient hospital coverage
$250 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$214 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$50-275 copay

Therapy services

Occupational therapy visit
$20 copay
Physical therapy & speech & language therapy visit
$20 copay

Mental health services

Outpatient group therapy with a psychiatrist
$20 copay
Outpatient individual therapy with a psychiatrist
$20 copay
Outpatient group therapy visit
$20 copay
Outpatient individual therapy visit
$20 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$20 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$399-699 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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