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Providence Health Plan Review

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UPDATED: Nov 30, 2018

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Connected with the Providence medical centers in the Pacific Northwest, Providence Health Plan offers a range of individual and family coverage options. They cover members in specific parts of Oregon, including the city of Portland.

About Providence

Providence has a long history that goes back to a Catholic mission in Quebec, Canada founded in 1843. The first Sisters of Providence arrived in the Pacific Northwest in 1856 and established the area’s first permanent hospital. Incorporated in 1859, the company began spreading up and down the coast, building more hospitals and medical centers.

Providence first offered health insurance as an HMO based out of their two major hospitals located in Portland, Oregon. By 1997 they had expanded and merged two separate health plans to form Providence Health Plan, which offers mainly PPO plans, a move away from the original HMO model.

Today, Providence offers their individual and family and Medicare Advantage plans to members in the northwest counties of Oregon, although medical services are offered in other locations. They have a wide variety of plans to choose from. Coverage can be purchased directly online or over the phone.

Providence Health Plan Products

Providence has a good selection of individual and family plans, some with nationwide networks and some with smaller networks.

Balance Plans

The Balance plans have a nationwide PPO network and cover both in and out-of-network providers. There are two choices available: Silver and Bronze.

The Balance 2500 Silver has a $2,500 individual deductible and $5,000 family deductible for in-network care. Out-of network deductibles are much higher $10,000 individual and $20,000 family. Copays are $25 for primary care and $50 for specialists in-network. Out-of-network care is covered at 50% coinsurance. Prescription drugs start at a $20 co pay for Tier 1.

The Balance 7150 Bronze plan has in-network deductibles of $7,150 individual and $14,300 family. Out-of-network deductibles are extremely high at $28,600 individual and $57,200 family. In-network primary care visits have a $50 copay, and there is no copay for specialist visits. Primary care and specialist visits out-of-network are covered at 100% after the deductible is met. Prescription drug coverage starts at $30 for Tier 1.

Choice Plans

The Choice plans are also PPO, but have a smaller in-network region, covering most counties in Oregon. Out-of-network care is available with a higher coinsurance and higher deductible. Like the Balance, there are two levels with the same deductibles.

The Choice 2500 Silver has the same deductibles and the same copays as the 2500 Balance plan, while the Choice 7150 Bronze matches the deductibles and coverage levels of 7150 Bronze. Prescription drug coverage is the same as the Balance plans. Unlike the Balance plan, however, out-of-network care has a 50% coinsurance after the deductible is met.

The major difference between these plans is the more limited coverage area for in-network care, which should equate to a lower premium.

Connect Plans

Connect plans again come with the same two levels of care and the same deductible choices. These plans are meant for people within the Portland metro area and cover only Multnomah, Clackamas, and Washington counties for in-network providers. As a PPO plan, however, out-of-network coverage is available.

Basic copays and prescription drug coverage for the Connect 2500 and 7150 plans are the same as the Choice plans. Again, due to the more limited coverage area, we would expect premiums to be lower for these plans.

Standard Plans

These plans meet the State of Oregon’s outlined standards for Gold, Silver, and Bronze levels of coverage. These plans provide a nationwide network.

The Standard Gold plan has a $1,000 individual in-network and $2,000 family deductible. Out-of-network deductibles are $4,000 individual and $8,000 family. The primary care copay is $20, and specialists are $40, in-network. Out-of-network visits have a 50% coinsurance amount. Prescription drugs start at $10 for Tier 1.

The Standard Silver plan has in-network deductibles of $2,500 individual and $5,000 family, while out-of-network deductibles are $10,000 individual and $20,000 family. In-network copays are $35 for primary care and $70 for a specialist visit, and again the out-of-network coinsurance is 50%. Prescription drugs start at $15.

The Standard Bronze plan carries a $7,150 in-network individual deductible, while the family deductible is $14,300. Like the other 7150 plans, the out-of-network deductibles amount skyrockets to $28,000 individual and $57,200 family. With this plan, out-of-network care is again covered at 100% after the deductible is met. Prescription drug coverage starts at $35 for Tier 1 drugs.

HSA Qualified Plans

Providence has two HSA Qualified options at the Silver and Bronze levels. These plans have a nationwide network and allow members to save pre-tax dollars in an HSA account to use towards out of pocket expenses.

The 2800 Silver plan has an individual deductible of $2,800 for in network care, and the family deductible is $5,600. The out-of- network deductibles are $11,200 individual and $22,400 family. All in-network office visits carry a 20% coinsurance, while out of network the coinsurance amount is 50%. Similarly, prescription drugs are covered with a 20% coinsurance.

The 6000 Bronze plan has a $6,000 individual deductible in-network, and a $12,000 family deductible. Out-of-network deductibles are $24,000 individual and $48,000 family. The coinsurance amounts, both out-of-network, and in-network are the same, as is the prescription drug coverage.

Providence Progressive Dental Plan

The dental plan can be added to any Providence Health Plan that is purchased directly from the company but cannot be purchased individually.

There is a low $25 individual deductible, and $75 family for in-network dental care. Out-of-network deductibles are doubled. The plan includes full coverage for all preventative care, and a range of coinsurance amounts for other services.

Medicare Advantage Plans

Providence has a good selection of Medicare Advantage plans that vary based on the county. Most plans are available with or without added Part D prescription drug coverage.

The Providence Medicare Extra is an HMO plan that has no deductible. Primary care visits cost $10 and specialist visits cost $15. If you choose the option that includes Rx coverage, copays start at $6.

The Providence Medicare Choice plan is an HMO-POS plan. Again, there is no deductible with this plan, and copays are $15 for primary care and $30 for specialists. Like the Extra plan, prescription drug benefits, if added, start at $6.

The Providence Medicare Prime plan is a $0 premium (after regular Medicare premiums) option that includes Part D coverage. Although there is no medical care deductible, this plan does have a $200 prescription drug deductible. Prescription copays begin at $7 for Tier 1.

The Providence Medicare Compass plan includes Part D coverage as well but does have a premium. There is no medical deductible and a $100 prescription deductible. Primary care copays are $15, and specialist visits $45. Prescription drug coverage starts with a $10 copay for Tier 1 drugs.

Providence Medicare Dual Plus is an HMO-SNP plan. It is also a $0 premium plan, the second offered by Providence. There is no deductible for in-network care, no copay for any office visits, and Tier 1 drugs start at $0.

Providence Medicare Latitude is an HMO-POS plan with no medical deductible and a $100 prescription deductible. Copays for in- network care are $15 primary and $45 specialist. After the deductible, prescription drug copays start at $10.

Providence also has add-on dental and vision benefits to enhance the coverage offered in any of the Medicare plans.

Providence Rates

There are a lot of plans to choose from at Providence, and rates vary based on the county of residence as well as the number of people being added to the plan. There is a very easy to use rate calculator.

To get a sample rate, we chose a single, 30-year-old, non-smoker living in Multnomah County. The lowest rate we returned was $215 a month for the HAS Qualified 6000 Bronze plan. The most expensive was the Standard Gold plan at $382 a month.

Providence lists all of the Medicare Advantage rates on the website as well, along with each summary of benefits. As mentioned, there are two plans available with no additional premium above the regular Medicare rate. Rates vary from there.

Providence charges increasing family rates for up to three children; after three there is no additional premium.

Claims

As a health insurance company, Providence will handle claims directly with providers. This is also true of Medicare plans. Not surprisingly, there is little information regarding claims readily available on the website.

Ratings and Consumer Reviews

Providence Health Plans has an A+ rating with the Better Business Bureau (BBB). There are only two complaints on file in the past three years and none in the past 12 months. There is one review on the BBB site that is negative but appears to be focused more on a Providence Medical Center than on the health insurance plan itself.

The review did point out one thing worth noting – that as a Catholic institution, Providence’s stance on health care may be impacted by the belief system of the founding faith.

In our search for reviews of this company, we found very little directly relating to the health plans, coverage, and service. This is not unusual for a local health plan like Providence.

The National Committee for Quality Assurance gives Providence a 3.5 overall, with a lower score of 2.5 in consumer satisfaction. The company performed particularly poorly in areas scoring Providence providers, however as most of the plans are PPO plans with a fairly large network, this experience may vary widely outside of Providence clinics.

Given the low complaint volume overall, Providence appears to have a fairly good reputation.

The Bottom Line

Providence is one of the largest local insurance providers in the Portland, Oregon area and has a really impressive array of available plans at various price points. Their very high out of network deductibles give the impression that they lean heavily on ensuring members use in-network services, although these do appear to be extensive. Providence will likely be a good fit for those who live within the main service area and do not anticipate a lot of out of network care needs.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

1 Comment

  1. Just need guidance prior to purchasing health insurance to include dental and vision for my family.

    Reply

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