Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H9047-013

Medicare Plan

Providence Medicare Extra Part B Only + Rx (HMO) · Providence Medicare Advantage Plans · HMO · Portland Metro and Lane

Full CMS plan ID: H9047-013-000

H9047-013-000 is the full CMS identifier for the H9047-013 Medicare plan. Common searches include H9047 013 and H9047013.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Providence Medicare Extra Part B Only + Rx (HMO)

H9047-013-000 Portland Metro and Lane HMO

At-a-glance

Quick view

01

In-network

Inpatient hospital

Part-B-only inpatient structure requires plan documents

02

Emergency transport

Ambulance

Ground · in-network$50–$275 copay
Air · in-network$50–$275 copay
03

Emergency services

Emergency room

$125 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$4,000
Combined in + outNot reported
05

Skilled care at home

Home health

In-networkCost share not reported
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premiumNot reported
Consolidated C + DNot reported

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkCost share not reported
Out-of-networkNot separately reported

Specialist

In-network$20 copay
Out-of-networkNot separately reported

Preventive care

In-networkCost share not reported
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-network20% coinsurance
Out-of-networkNot separately reported

Laboratory services

In-networkCost share not reported
Out-of-networkNot separately reported

X-rays & standard imaging

In-network15% coinsurance
Out-of-networkNot separately reported

MRI, CT & PET imaging

In-network15% coinsurance
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$125 copay
Out-of-networkNot separately reported

Ground ambulance

In-network$50–$275 copay
Out-of-networkNot separately reported

Air ambulance

In-network$50–$275 copay
Out-of-networkNot separately reported

Outpatient hospital

In-network$150 copay
Out-of-networkNot separately reported

Outpatient surgery / ASC

In-network$100 copay
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

In-networkCost share not reported
Out-of-networkNot separately reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-network$20 copay
Out-of-networkNot separately reported

Occupational therapy

In-network$20 copay
Out-of-networkNot separately reported

Physical & speech therapy

In-network$20 copay
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

In-networkCost share not reported
Out-of-networkNot separately reported

Substance use treatment

In-network$20 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

In-network$20 copay
Out-of-networkNot separately reported

Chiropractic

In-network$20 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

In-network$20 copay
Out-of-networkNot separately reported

Vision

In-networkCost share not reported
Out-of-networkNot separately reported

Hearing

In-network$499–$999 copay
Out-of-networkNot separately reported

Transportation

Not reported in this CMS export

Not reported in this CMS export

Fitness & wellness

Not reported in this CMS export

Not reported in this CMS export

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

Not reported in this CMS export

Not reported in this CMS export

Plan costs & rulesCoverage overview

Premium & Part B giveback

Part C premium not reported · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$4,000
Combined in + outNot reported

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

HMO · Referrals: Not required · Out-of-network coverage: No

Prescription drugs5 tiers

Part D deductible

This plan is not present in the public CMS Landscape release

Drug tier 1

$12 retail copay · 30-day supply

Drug tier 2

$20 retail copay · 30-day supply

Drug tier 3

$47 retail copay · 30-day supply

Drug tier 4

$100 retail copay · 30-day supply

Drug tier 5

33% retail coinsurance · 30-day supply

Using this plan

Understand H9047-013-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Providence Medicare Extra Part B Only + Rx (HMO) is a 2026 HMO offered by Providence Medicare Advantage Plans in Portland Metro and Lane. The CMS record does not indicate routine out-of-network coverage. The plan record does not require referrals.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Cost share not reported
Specialist
$20 copay
Laboratory services
Cost share not reported

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
20% coinsurance
MRI, CT & PET imaging
15% coinsurance
Outpatient hospital
$150 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$125 copay

Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Portland Metro and Lane (CA, OR, WA)
Plan type
HMO
Contract / plan
H9047-013
Coverage year
2026

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental$20 copay
VisionCost share not reported
Hearing$499–$999 copay

Plan-specific answers

Frequently asked questions

Where is H9047-013-000 available?

Providence Medicare Extra Part B Only + Rx (HMO) is listed for Portland Metro and Lane (CA, OR, WA). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the in-network maximum out-of-pocket limit for H9047-013-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $4,000. Prescription drug spending generally does not count toward this medical limit.

What does an emergency room visit cost on H9047-013-000?

The plan record lists $125 copay, waived when an admission meets the plan's stated timing rule.

Does H9047-013-000 report extra benefits?

Yes. CMS reports dental, vision, hearing. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H9047-013-000 fits

Full CMS plan ID
H9047-013-000
Contract
H9047
Base plan code
H9047-013
Segment
000
Carrier
Providence Medicare Advantage Plans
Plan type
HMO
Service area
Portland Metro and Lane (CA, OR, WA)

County/service-area foundation

CMS service-area entries

These named entries come from a CMS contract-level service-area file. They describe the contract's published geography and must not be treated as proof that every segment has identical county-level rules.

  • Orange, CA
  • Benton, OR · employer/group only
  • Clackamas, OR
  • Columbia, OR · employer/group only
  • Crook, OR · employer/group only
  • Deschutes, OR · employer/group only
  • Hood River, OR
  • Jefferson, OR · employer/group only
  • Lane, OR
  • Linn, OR · employer/group only
  • Marion, OR · employer/group only
  • Multnomah, OR

10 additional service-area entries are retained in the data record.

Same CMS contract

H9047-033-000 Providence Medicare Focus Medical (HMO) Portland Metro, Lane, Hood River, Clark WA · HMO H9047-037-000 Providence Medicare Prime + Rx (HMO) Portland Metro · HMO H9047-043-000 Providence Medicare Dual Plus (HMO D-SNP) Clackamas, Multnomah, Washington counties · HMO H9047-054-000 Providence Medicare Timber + Rx (HMO) Lane, Hood River, Clark WA counties · HMO H9047-063-000 Providence Medicare Pine + Rx (HMO) SE WA, Spokane and Snohomish counties · HMO H9047-064-000 Providence Medicare Extra + Rx (HMO) Portland Metro, Lane, Hood River, Clark WA · HMO H9047-066-000 Providence Medicare Sycamore + Rx (HMO) Orange County · HMO H9047-804-000 Providence Medicare Align Group Plan + Rx (HMO) Portland, Willamette Valley,Central OR, Washington · HMO

About this code

What H9047-013-000 identifies

H9047-013-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H9047-013, H9047 013, or the compact full CMS ID H9047013000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.

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