Medicare members

You want to know how health care reform will affect you. We want to make it easy for you to understand. Visit this website to stay informed about plan decisions and reform updates.

What has changed?

In 2013, even if you reach the coverage gap (donut hole) in your Medicare prescription drug coverage (Part D), you’ll pay only 47.5% for covered brand-name drugs and 79% for generic drugs.

In 2013, you will continue to pay $0 for certain Preventive & Screening services. In addition Medicare has added screening and counseling for depression, alcohol misuse, cardiovascular disease, and obesity to this list of covered services.

Frequently Asked Questions

Rule-making on health care reform continues at federal and state levels. As these new rules are defined, we will notify you of any changes to your plan or benefits. In the meantime, we'd like you to know that it's business as usual at Providence Health Plan. Please enjoy your health plan benefits and our 24-hour nurse advice line. We will update our website with the latest information.

What is happening to Medicare?

Health care reform will improve the quality of care in Medicare, reduce costs for seniors, and make sure Medicare is there for them in the future. The government will continue to fund Medicare, and Providence Health Plan intends to continue offering Medicare Advantage Plans.

When will I find out if health care reform changes my health plan?

We will mail information regarding plan changes to you in advance of any changes. Medicare Advantage Plans, like Providence Medicare Advantage Plans, are approved by the government to administer Part A and Part B benefits. In general, we are not allowed to make any changes to your plan during the year. If there are any changes to your plan for next year we will tell you in September and the change will take effect on January 1. With that said, sometimes Medicare adds coverage under Original Medicare for new services during the year. If Medicare adds coverage for any services during 2013, we will also cover those services.

What is happening with the coverage gap (donut hole)? Will I see more savings?

The coverage gap is closing. In 2013, you will receive even more help in the coverage gap. Even if you reach the coverage gap (donut hole) in your Medicare prescription drug coverage (Part D), you’ll pay only 47.5% for covered brand-name drugs and 79% for generic drugs. The percentage you save in the coverage gap (Medicare prescription drug coverage) will increase each year through 2020. By 2020, you’ll pay only 25% for covered brand-name and generic drugs during the gap.

Am I going to lose my coverage?

No, Providence Health Plan has been in the Medicare Managed Care business for 27 years, and we expect to continue to offer Medicare Advantage Plans. Currently, Providence Health Plan is contracted with the Centers for Medicare & Medicaid Services (CMS) to offer Medicare Advantage Plans through the 2013 plan year.

Will my premium increase?

At Providence Health Plan we strive to offer exceptional care at a reasonable price. In 2013, some premiums decreased, some increased, and some stayed the same. Premiums can change from year to the next; however we are not allowed to make changes to your premium during the year. If there are any changes to your premium for the next year we will tell you in September and the change will take effect on January 1.

The benefit information provided here is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitation, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year.