Frequently Asked Questions

You’re not alone. Medicare is confusing and we’re here to help you understand how the program works and what options you have.

Explore the topics below for helpful information about Medicare:

  • How do I find the right plan?
    • Ask your physician(s) 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.
    • If you take prescription drugs, review Medicare plan drug lists to see if your prescriptions are covered.
    • Go to the websites of the health insurance companies on your list to review information about premiums and coverage.
    • 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.
    • Go to a virtual community meeting, call to talk to a Medicare Advantage representative, or make an appointment to see a 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, if your primary care provider is in our network.


    Check our provider and pharmacy directory to see if your current doctor is part of the Providence team. You can also call 503-574-5551 or 1-800-457-6064; TTY 711.

  • I have insurance through my employer or spouses 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.


    Small company (fewer than 20 employees):

    Enroll in Medicare Part B. Your employer assumes that you have enrolled; and if you don’t enroll in Part B, you will pay for the services 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.



    Large company:

    Ask your employer. Some companies do cover Part B and some do not. Some employer plans may also be 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 an 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 or 1-800-772-1213 (TTY: 1-800-325-0078), or visit your local Social Security Office.

  • If I have prescription drug coverage through my employer or my spouses 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?

    You get mail!


    We will send you a packet of materials that explain how to use your coverage. Please read these materials when you get them.


    Call us if you need help or have any questions, we’re happy to accommodate you.


    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 – Dec. 7) or Monday through Friday (Dec. 8 – Sept. 30).

  • How do I get help?

    If you need enrollment help or want more information about Providence Medicare Advantage Plans, please call us at 503-574-5551 or 1-800-457-6064 (TTY 711).


    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.

  • How can I change plans?

    To enroll in a different Providence Medicare Advantage Plan follow the steps below:

     

    1. Print the change form: 

    2. Complete the form.

    3. Mail to Providence Medicare Advantage Plans at:

      • Providence Medicare Advantage Plans
        P.O. Box 5548
        Portland, OR 97228-5548
      • Or fax to 503-574-8607

    You will receive a notice in the mail acknowledging receipt of the completed plan change or a request for additional information if the form is not complete.

  • When can I change plans?

    Members may enroll in a plan during the 2021 Annual Enrollment Period from October 15 through December 7.


    Beneficiaries have the option of changing plans and adding or dropping Part D Coverage. Contact Customer Service for details.


    The 2021 Medicare Advantage Open Enrollment period is from January 1 to March 31. During this time, members may enroll in another Medicare Advantage plan, or disenroll from their Medicare Advantage plan and return to Original Medicare. Individuals may make only one election during the Open Enrollment period.



    Optional supplemental coverage:

    Members may elect to purchase optional supplemental dental coverage up to 60 days after their effective date.


    Follow these steps to add optional supplemental coverage:


    1. Print the supplemental dental application:

    2. Complete the form

    3. Mail to Providence Medicare Advantage Plans at:
      Providence Medicare Advantage Plans
      P.O. Box 5548
      Portland, OR 97228-5548

      or

      Fax to: 503-574-8607

    Providence Medical Advantage Plans’ contract with CMS is renewed annually and the availability of coverage beyond the end of the current contract year is not guaranteed.

  • How do I use my member ID card?

    You will receive a member ID card in the mail (if you haven’t already) after you enroll. Please carry it with you as you’ll need it when you receive services.

  • How do I get care during a disaster?

    If you need healthcare during a disaster and you cannot access an in-network provider, you may obtain care from an out-of-network provider.


    Providence Medicare Advantage Plans will cover services rendered by out-of-network providers during a disaster at in-network costs. This coverage is available regardless of the type of plan you are enrolled in. You may not need prior approval from Providence Medicare Advantage Plans to receive out-of-network care during a disaster.


    If you have prescription coverage, Providence Medicare Advantage Plans will also cover, at in-network cost, any prescriptions that you fill at an out-of-network pharmacy during a disaster.


    A disaster is an event that occurs in a specific geographic location. An event qualifies as a disaster if: 


    • The President of the United States declares the event to be an emergency or disaster under the National Emergencies Act or the Stafford Act
    • The Secretary of the Department of Health and Human Services declares it to be a public health emergency under the Public Health Service Act
    • The Governor declares it to be an emergency or disaster

    If you aren’t sure of the status of a disaster, please visit https://www.fema.gov/disasters.


    Your healthcare provider will need to bill Providence Medicare Advantage Plans for any care you receive during the disaster. They must do this regardless of the status of their contract with Providence Medicare Advantage Plans.


    Depending on the severity of the event, there may be a delay in the time it takes to process your claims. If a delay occurs, you will be notified by mail.


    If you have questions or concerns, please call Providence Medicare Advantage Plans customer service at 1-800-603-2340 or 503-574-8000; TTY: 711. Someone is available to take your call between 8 a.m. and 8 p.m., seven days a week (Pacific time).

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