Providence Medicare Focus Medical (HMO)
Medicare Advantage Plan H9047-033 • 2026
Providence Medicare Focus Medical (HMO) Medicare Advantage Plan H9047-033 • 2026
The Medicare Advantage plan identified by CMS Plan ID H9047-033 (Providence Medicare Focus Medical) is a HMO Part C plan offered by Providence Medicare Advantage Plans for the 2026 plan year. It uses a Health Maintenance Organization (HMO) provider network and comes without drug coverage (Part D prescriptions).
Providence Medicare Focus Medical Overview
Plan Overview for H9047-033-0 |
|
|---|---|
| CMS Plan ID: | H9047-033-0 |
| Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $4200.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | See List |
| Enrollment (Nationwide) | 179 beneficiaries |
| Provided By: | Providence Medicare Advantage Plans |
Plan Availability
Providence Medicare Focus Medical (H9047-033-0) is available in the following locations (click to open):
Coverage Overview for Providence Medicare Focus Medical
Providence Medicare Focus Medical is a Medicare Advantage HMO plan that provides Medicare Part A and Part B coverage through a network of participating providers. The monthly premium is $0.00, and the plan generally requires selection of a primary care provider (PCP) and use of in-network services, except in emergency situations.
Primary care visits have a $0 copay, specialist visits come with a $20 copay, lab services cost {lab_services_cost}, urgent care services carry a $25 copay, and ambulance transportation is $50-$275 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $4200.00. After this limit is reached, in-network services are fully covered.
This plan is listed by CMS under Plan ID {title_plan_id}. A summary of cost sharing is provided below.
Cost-Sharing Overview
Providence Medicare Focus Medical has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H9047-033.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $20 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$20 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | Not covered |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: 15% coinsurance |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay |
| Diagnostic tests and procedures: | In-network: 20% coinsurance |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $130 copay |
| Worldwide emergency care: | $130 copay |
| Urgent care: | $25 copay |
| Inpatient hospital care: | Tier 1 | $250 per day for days 1-5 | $0 per day for days 6-90 | $0 Lifetime Reserve Days for days 1-60 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $218 per day for days 21-100 |
| Ground ambulance: | In-network: $50-$275 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $20 copay |
| Outpatient group therapy: | In-network: $20 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $250 per day for days 1-5 | $0 per day for days 6-90 | $0 Lifetime Reserve Days for days 1-60 | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $20 copay |
| Occupational therapy: | In-network: $20 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-network: $0 copay |
| Endodontics: | Not covered |
| Restorative services: | Not covered |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | In-network: $0 copay |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $499-$999 copay |
| OTC hearing aids: | Not covered |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | In-network: $0 copay |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | In-network: $0 copay |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Providence Medicare Focus Medical as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Ratings
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
What is the monthly premium for Providence Medicare Focus Medical (HMO)?
The plan’s monthly premium is $0.00 for 2026. The Part B premium is not included.
What is the MOOP for Providence Medicare Focus Medical in 2026?
The annual in-network MOOP is $4200.00 for 2026. After this limit is reached, covered in-network services are fully paid.
What is the current enrollment for Providence Medicare Focus Medical?
Total enrollment is 179 beneficiaries based on the latest CMS data.
What is the prescription drug deductible for 2026?
The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.
Contact Information for Providence Medicare Advantage Plans
| Contact Type | Details |
|---|---|
| Website: | Providence Medicare Advantage Plans Plan Page |
| New Members: | 1-800-457-6064 |
| Existing Members: | 1-800-603-2340 |
| Plan Address: | P.O. Box 4327 | Portland, OR 97208 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- Providence Medicare Advantage Plans (official source), http://www.ProvidenceHealthAssurance.com — Last accessed October 13, 2025
- Medicare.gov, "Compare types of Medicare Advantage Plans" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — Last accessed 25 May, 2025
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Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.