Service area questions

What happens if Providence Medicare Advantage Plans leaves the Medicare program, or if the Providence Medicare Advantage Plans service area changes and there is no longer a plan in the area where I live?

If we leave the Medicare program or change our service area so that it no longer includes the area where you live, you will receive written notice in the mail. If this happens, your membership in Providence Medicare Advantage Plans will end, and you will need to get your Medicare benefits through another private health insurance provider or through Original Medicare. All of the benefits and rules described in your evidence of coverage will continue until your membership ends. This means that you must continue to get your medical care in the usual way through Providence Medicare Advantage Plans until your membership ends.

What other choices will I have for getting Medicare?

Your choices for how to get Medicare benefits will always include Original Medicare and joining a Prescription Drug Plan to complement your Original Medicare coverage. Your choices may also include joining another Providence Medicare Advantage Plan, another private insurance provider’s Medicare Advantage Plans, or a Private Fee-for-Service plan, if these plans are available in your area and are accepting new members. Once we have told you in writing that we are leaving the Medicare program or the area where you live, you will have a chance to change to another way of getting your Medicare benefits. If you decide to change from Providence Medicare Advantage Plans to Original Medicare, you will have the right to buy a Medigap policy regardless of your health. This is called a “guaranteed issue right.”

Providence Medicare Advantage Plans has a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare. At the end of each year, the contract is reviewed, and either Providence Medicare Advantage Plans or CMS can decide to end it. You will receive 90 days advance notice in this situation. It is also possible for our contract to end at some other time during the year, too. In these situations we will try to tell you 90 days in advance, but your advance notice may be as little as 30 or fewer days if CMS must end our contract in the middle of the year.

Whenever a Medicare health plan leaves the Medicare program or stops serving your area, you will be provided a special enrollment period to make choices about how you get Medicare, including choosing a Medicare Prescription Drug Plan and guaranteed issue rights to a Medigap policy.