Service Area Questions

 

Contact us

Customer Service
503-574-8000 or
800-603-2340
M-Sun, 8 a.m. to 8 p.m.

Medicare Advantage Sales
503-574-5551 or
800-457-6064

TTY: 711
M-Sun, 8 a.m. to 8 p.m.

Mailing Address


What happens to me if Providence Health Plan leaves the Medicare program, or if Providence Medicare Advantage Plans leaves 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, we will tell you in writing. If this happens, your membership in Providence Medicare Advantage Plans will end, and you will have to change to another way of getting your Medicare benefits. 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.

Your choices for how to get your Medicare 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 Health Plan plan, another Medicare Advantage Plan, 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” and it is explained earlier in this section under the heading, “Do you need to buy a Medigap (Medicare supplement insurance) policy?”

Providence Health Plan 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 Health Plan or CMS can decide to end it. You will get 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.