Understanding Medicare

If you’re new to Medicare it can be confusing. Were here to answer your questions and help you make an informed decision. If you don’t find the answers you‘re looking for, attend one of our Providence Medicare Advantage Plans informational meetings virtually from the comfort of your home. Get your questions answered and speak to a Providence representative, all in one place.

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  • What is Medicare?

    Medicare is an insurance program offered through the federal government that covers medical services and hospital care for people 65 or older, younger people with certain disabilities, and people with End Stage Renal Disease (ESRD). Medicare is made up of Part A, Part B, Part C, and Part D. Sometimes referred to as Original Medicare, Part A and Part B are provided by the federal government. Part C and Part D are provided by private health insurance companies but still follow federally mandated Medicare guidelines.


    Information taken from cms.gov.

  • What is Medicare Part A: Hospital coverage

    Also known as hospital insurance, Medicare Part A covers inpatient services including hospital care, skilled nursing facility care, nursing home care, hospice and home health services. Part A is included in the federally provided Original Medicare, but can also be included in Part C Medicare Advantage Plans provided by private insurance companies.


    What it costs

    To find out what your costs would be for Medicare Part A coverage, please visit the Medicare costs at a glance on the Medicare.gov website.


    This information is not a complete description of benefits. Call 1-800-603-2340 TTY: 711 for more information.


    Information taken from cms.gov.

  • What is Medicare Part B: Outpatient/physical services coverage

    Also known as outpatient medical insurance, Part B covers medically necessary and preventive services such as lab tests, surgeries and doctor visits, and supplies such as wheelchairs and walkers (considered medically necessary to treat a disease or condition).


    Part B is optional and can be purchased as part of the federally provided Original Medicare but can also be included in Part C Medicare Advantage Plans provided by private insurance companies.


    You must have Part B to enroll in a Medicare Advantage Plan.


    What it costs

    To find out what your costs would be for Medicare Part B coverage, please visit the Medicare costs at a glance page on the Medicare.gov website.


    This information is not a complete description of benefits. Call 1-800-603-2340 TTY: 711 for more information.


    Information taken from cms.gov.

  • What is Medicare Part C: Medicare Advantage Plans

    Also known as Medicare Advantage Plans, Part C is an alternative to Part A and Part B and is provided by private health insurance companies (like Providence) who are approved by Medicare. Part C covers all the benefits you receive with Part A and Part B and may offer additional benefits such as dental care, gym memberships, vision care, and prescription coverage (Part D). If you join a Medicare Advantage Plan (Part C), you will still have Original Medicare but will get your Part A and Part B coverage from your Medicare Advantage Plans provider with the exception of hospice care, which will still be provided through Part B. You must also continue to pay your Medicare Part B premium.


    What it costs


    • Monthly premiums, annual deductibles and costs for services (co-pays and co-insurance) vary by health insurance provider and the plan you choose.
    • You will also continue to pay your Medicare Part B premium even if you choose Part C through a private health insurance provider.
    • For more information, contact a Providence Medicare Advantage Plans representative today.

    This information is not a complete description of benefits. Call 503-574-8416 or 1-888-266-7338 TTY: 711 for more information.


    Information taken from cms.gov.

  • What is Medicare Part D: Prescription drug coverage

    Also known as Medicare Prescription Drug insurance, Part D is offered by private health insurance companies such as Providence. If you have Part A and Part B, or if you have a Part C Medicare Advantage Plan, you may choose to purchase a separate Part D prescription plan from a private health insurance provider. Some Medicare Advantage Plans already include Part D prescription coverage. If you have a Medicare Advantage Plan (Part C) that doesn’t include prescription coverage and you would like to add a Part D prescription plan, it must be provided by the same health insurance company as your Medicare Advantage Plan.


    The prescriptions covered by a Part D plan can vary by health insurance provider, so be sure to review the plan’s approved prescription drug list or “formulary”, prior to making a selection. Part D formularies include a list of covered medications and a description of the transition benefit for existing Part D eligible prescriptions.


    What it costs

    Monthly premium costs and prescription co-pays will vary by health insurance provider and the plan you choose.


    Information taken from cms.gov.

  • What is Medigap: Medicare supplemental insurance

    Also known as Medicare supplemental insurance, Medigap is another option for filling in coverage gaps in Original Medicare (Part A and Part B). Medigap policies are sold by private insurance companies and allow you to choose any Medicare-certified doctor or hospital regardless of network. Medigap plans are only an option if you are enrolled in Original Medicare (Part A and Part B) and not a Medicare Advantage plan.


    For information about Medigap plans, visit www.Medicare.gov.


    Information taken from cms.gov.

  • Who is eligible?

    Several factors can contribute to Medicare eligibility. You are eligible to enroll in Medicare if:


    • You are turning 65
    • You are younger than 65 but qualify for Medicare due to a qualifying disability*
    • You have end stage renal disease (ESRD)
    • You have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease)

    * Must have received Social Security Disability benefits for 24 months. There is a five month waiting period after a beneficiary is determined to be disabled before a beneficiary begins to collect Social Security Disability benefits.


    Information taken from cms.gov

  • When can I enroll?

    Initial Enrollment

    Your initial enrollment period (IEP), also called your initial coverage election period (ICEP), is determined by your birthday. The initial enrollment period lasts seven months: the three months before your birthday, the month of your birthday, and the three months following your birthday.



    Special Enrollment Periods

    Given certain life circumstances, you may be eligible for a special enrollment period (SEP). Circumstances may include the following:


    • If you are moving (even if you stay in your current plan’s selling area, you may be able to switch plans if there are new plan options available in your new location)
    • If you have moved out of an institution, such as a long-term care or skilled-nursing facility
    • If you are no longer eligible for Medicaid
    • If your plan has changed its contract

    For the full list of qualifying circumstances, go to www.cms.gov.



    Annual Enrollment Period

    Also referred to as annual election period (AEP), the annual enrollment period is October 15th through December 7th, and when you can make plan changes. If you don’t currently have prescription coverage (Part D) you can also add it during this time. If you’re happy with your current coverage, you don‘t need to do anything and will be automatically re-enrolled for the next calendar year. Any changes you make will take effect January 1 of the next calendar year.



    Medicare Advantage Open Enrollment Period

    The 2021 open enrollment period is from January 1 to March 31, 2021. 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.


    Information taken from www.cms.gov.


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