Common questions

Put your mind at ease

Few things in life are as precious to us as our health. We know that before you trust your health care coverage to Providence Medicare Advantage Plans you want to know that we'll be here for you when you need us. These questions and answers explain Providence Medicare Advantage Plans and should help put your mind at ease.

When does Medicare coverage start?

Medicare coverage starts on your Medicare effective date. Your effective date is the first of the month in which you turn 65, unless your birthday is on the first of the month. If your 65th birthday is on the first of the month, Medicare will start on the first of the month that precedes your 65th birthday. For example:

  • If you turn 65 on Aug. 15, your Medicare effective date will be Aug. 1.
  • If you turn 65 on Aug. 1, your Medicare effective date will be July 1.

What are Medicare Parts A and B?

Medicare Part A provides coverage for inpatient services, such as a hospitalization or a stay in a skilled nursing facility.

Medicare Part B provides coverage for outpatient services, such as a visit to the doctor, lab work or emergency room care.

How do I enroll in Medicare Parts A and B?

  • If you collect Social Security at or before age 65, the Social Security Department will automatically enroll you in Medicare Parts A and B. You should receive your Medicare card from the Social Security Administration about three months before your 65th birthday.
  • If you are celebrating your 65th birthday and are not collecting Social Security, or if you are losing group coverage, then you need to contact the Social Security office, www.ssa.gov or 1-800-772-1213, to enroll in Medicare Parts A and B.

Who is eligible?

You can enroll in a Providence Medicare Advantage plan if:

  • You are entitled to Medicare Part A (hospital coverage) and enrolled in Medicare Part B (medical coverage).
  • You live in a county where Providence Medicare Advantage Plans are offered.
  • You do not have end-stage renal (kidney) disease (Some exceptions may apply).

If you obtain routine care from out-of-plan providers neither Medicare nor Providence Health Assurance will be responsible for the costs except in emergency or urgent care situations or for out-of-area renal dialysis. Some exceptions apply to members of Providence Medicare Choice (HMO-POS) who choose to use their point of service benefit. Please contact plan for details or refer to the Summary of Benefits for your plan.

Members may enroll in a plan only during specific times of the year. Contact customer service for more information.

Providence Health Assurance's contract with CMS is renewed annually and that the availability of coverage beyond the end of the current contract year is not guaranteed.

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. Go to the websites of the health insurance companies on your list, and review information about premiums and coverage.
  3. Ask questions. You'll want answers that help you to do the following: understand how you'll use the plan, decide what is important to you, and evaluate premium and coverage options.
  4. 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?

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

We call this doctor your "primary care provider." To find out whether your current doctor is part of the Providence team, please view our provider directory, or call 503-574-5000, or 1-800-988-0088. TTY:711 (For the hearing impaired).

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. Your 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 owe a penalty.

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 locally at 503-574-5551 or toll free at 1-800-457-6064. We are open seven days a week, between 8 a.m. and 8 p.m. (Pacific Time).

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.

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Website is current as of 11/27/2017