Providence Medicare Sycamore + Rx (HMO) H9047-066-0 Plan Details
Providence Medicare Sycamore + Rx (HMO) H9047-066-0 Plan Details
When selecting a Medicare Advantage plan for 2026, it's important to compare all your options. Providence Medicare Sycamore + Rx (HMO) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
Based on the most recent CMS data, plan enrollments topped 8,710 members.
Providence Medicare Sycamore + Rx Overview
| Plan ID H9047-066-0 Overview | |
|---|---|
| Health Plan ID: | H9047-066-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $400.00 (In-Network) |
| Part B Give Back: | −$10.00 reduction |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | See List |
| Insured By: | Providence Medicare Advantage Plans |
Plan Availability
Providence Medicare Sycamore + Rx (H9047-066-0) is available in the following locations (click to open):
Explore the Benefits of Providence Medicare Sycamore + Rx
Providence Medicare Sycamore + Rx is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that combines hospital, medical, and drug coverage into one streamlined option. With a monthly premium of $0.00, it includes all benefits under Medicare Part A and Part B, along with built-in prescription drug coverage. The annual Part D deductible is $0.00. You’ll typically need to use doctors and providers in the plan’s network, except for emergency situations.
Primary care visits have a $0 copay, specialist visits come with a $0 copay, urgent care services carry a $0 copay, and ambulance transportation is $100 copay. These costs all apply toward the plan’s maximum out-of-pocket (MOOP) limit of $400.00. Once that limit is met, all in-network healthcare services are fully covered for the rest of the year. That’s a major plus for those who want both medical and drug coverage bundled into one predictable package.
This plan is listed by CMS as H9047-066-0. You’ll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
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Out-of-Pocket Expenses
With Providence Medicare Sycamore + Rx, you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H9047-066-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $0 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over the counter drug benefits: | Not covered |
| Health transportation (non-emergency): | Not covered |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $150 copay |
| Wordwide emergency care: | $150 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | Tier 1 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $100 per day for days 21-100 |
| Ground ambulance: | In-network: $100 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $0 copay |
| Outpatient group therapy: | In-network: $0 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 copay |
| Occupational therapy: | In-network: $0 copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0 copay |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay |
| Diagnostic tests and procedures: | In-network: $0 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-network: $0 copay |
| Endodontics: | In-network: $0 copay |
| Restorative services: | In-network: $0 copay |
| Implant services: | In-network: $0 copay |
| Orthodontics: | In-network: $0 copay |
| Oral/Maxillofacial surgery: | In-network: $0 copay |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| 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 |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | Not covered |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | Not covered |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy 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 Sycamore + Rx as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Providence Medicare Sycamore + Rx includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $0.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $12.00 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Providence Medicare Advantage Plans starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Providence Medicare Sycamore + Rx may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | $40.00 copay | Coming soon |
| Non-Preferred Drug | $100.00 copay | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Understanding CMS Star Ratings
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in Providence Medicare Sycamore + Rx?
You are eligible to enroll in Providence Medicare Sycamore + Rx if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for Providence Medicare Sycamore + Rx and take advantage of its full range of benefits.
When Can I Enroll in Providence Medicare Sycamore + Rx?
Knowing when you can enroll in Providence Medicare Sycamore + Rx is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
Steps to Enroll in Providence Medicare Sycamore + Rx
Enrolling in Providence Medicare Sycamore + Rx is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Providence Medicare Sycamore + Rx through the official Medicare website.
- Directly with Providence Medicare Sycamore + Rx: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Here are some of the most frequently asked questions people have about plan ID H9047-066-0:
Is there a premium for this plan in 2026?
The 2026 premium is $0.00 each month, and you must continue to pay your Part B premium.
What is the annual out-of-pocket maximum on this plan?
For 2026, the maximum you’d spend out-of-pocket in-network is $400.00.
How much do I pay before drug coverage starts?
You’ll pay the first $0.00 in drug costs before coinsurance kicks in.
What’s the CMS star score for Providence Medicare Sycamore + Rx?
CMS rates it ★4.0 out of 5 stars for 2026.
How many people are enrolled in this plan?
CMS reports 8,710 members in the latest file.
Contact 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 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Providence Medicare Advantage Plans, http://www.ProvidenceHealthAssurance.com — Last accessed October 13, 2025
- Medicare.gov, "Compare types of Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — Last accessed 25 May, 2025
You can compare Plan-ID H9047-066 with the full list of 2026 Medicare Advantage plans, organized by state and county.
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Page content managed by David Bynon, Medicare Analyst.
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