Frequently asked questions

How do I find the right plan?

  1. Ask your physicians which Medicare Advantage Plans they accept. This is a good way to start because it narrows down the list of possibilities for you to research. If your physician doesn’t accept Medicare, we can help you find one who does.
  2. If you take prescription drugs, review Medicare plan drug lists to see if your prescriptions are covered.
  3. Go to the websites of the health insurance companies on your list to review information about premiums and coverage.
  4. Ask questions. You’ll want answers that help you understand how you’ll use the plan, help you decide what is important to you and help you evaluate premium and coverage options.
  5. Go to a community meeting, call to talk to a sales representative or make an appointment to see a sales representative in person. Have a conversation and keep asking questions until you have all the answers you need.

Do I get to pick my own doctor?

Yes! To help you get the health care you need, we ask that you build a relationship with one doctor with whom you feel comfortable, someone you trust and who can get to know you and your health history.

We call this doctor your primary care provider. If you choose Providence Medicare Advantage Plans you must select a primary care provider in our network. To find out whether your current doctor is part of the Providence team, please see the provider and pharmacy directory or call 503-574-5551 or 1-800-457-6064; TTY 711.

The provider network may change at any time. You will receive notice when necessary.

If I have insurance through my employer or my spouse's employer, do I need to enroll in Medicare Part B?

It depends. If you are covered on a retirement group plan, you probably need to enroll in Medicare Parts A and B. However, if you or your spouse is actively employed or are covered under group coverage, consider the size of the employer in determining whether or not to waive your Medicare Part B.

  • If the employer is small (fewer than 20 employees), it’s in your best interest to enroll in Medicare Part B. The employer assumes that you have enrolled; and if you don’t have Part B, you will pay for the services that Part B would have covered. For example, if you see a physician and are charged $100, and your employer group’s plan covers $20, you will owe $80 if you haven’t signed up for Part B.
  • If the employer is large (20 or more employees), ask questions to understand whether and how your employer’s plan covers Part B services, and whether the plan is considered creditable coverage. “Creditable” means that the plan pays as much as or more than Part B would pay. If you don’t have creditable coverage and you sign up for Part B after your initial election period, you will have to pay a penalty.

What is the Income-Related Monthly Adjusted Amount (Part D-IRMAA)?

If you have a higher income, you will pay a higher premium for your Medicare prescription drug coverage (Part D). The extra premium amount is called the Income-Related Monthly Adjustment Amount (Part D-IRMAA). You must pay both the extra amount as well as your plan's premium each month in order to keep Medicare prescription drug coverage.

Social Security will send you a letter if you have to pay extra for your Medicare prescription drug coverage. Social Security's letter explains how they determine the amount you must pay and the actual amount. If you disagree with the amount, contact the Social Security Administration at www.socialsecurity.gov/mediinfo.htm or 1-800-772-1213 (TTY: 1-800-325-0778), or visit your local Social Security Office. 

If I have prescription drug insurance through my employer or my spouse's employer, do I need to enroll in Medicare Part D?

It depends. If the employer prescription drug plan is considered creditable coverage, you don’t need to enroll in a Part D prescription drug plan. If the employer prescription drug plan is not considered creditable coverage, you will be subject to the monthly penalty if you do not enroll in a Part D prescription drug plan. You and/or your Medicare-eligible spouse should receive a letter from the employer about whether the employer’s prescription drug plan meets the Medicare definition of creditable coverage.

What happens after I join?

We will send you a packet containing your Member Handbook/Evidence of Coverage and other materials that explain how to use your coverage. Please read these materials when you get them.

Call us if you have special needs, we'd be glad to accommodate you. We'll also send you a member identification card.

Note: This information is only an overview of benefits from Providence Medicare Advantage Plans. A complete explanation of benefits, limitations and exclusions can be found in the Member Handbook/Evidence of Coverage and Summary of Benefits.

If you have other questions, please contact the Providence Medicare Advantage Plans Sales Team at 503-574-5551 or 1-800-457-6064 (TTY 711). Service is available Monday through Friday, between 8 a.m. and 8 p.m. (Pacific time), seven days a week (Oct. 1 – Feb. 14) or Monday through Friday (Feb. 15 –Sept. 30).

Help is here

If you need enrollment help or want more information about Providence Medicare Advantage Plans, please call the phone numbers listed on this page.

Providence Medicare Advantage Plans is an HMO, HMO-POS, and HMO SNP plan with a Medicare and Oregon Health Plan contract. Enrollment in Providence Medicare Advantage Plans depends on contract renewal.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;
  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
  • Your State Medicaid Office
  • SHIBA for Oregon and Washington

This information can be found in the member handbook.

Providence Medicare Advantage Plans Medicare Prescription Drug Benefits are only available to members of Providence Medicare Advantage Plans.