Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare...

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Simplifying Medicare A quick-read guide to Medicare parts, plans, and possibilities.

Transcript of Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare...

Page 1: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

SimplifyingMedicareA quick-read guide to Medicare parts, plans, and possibilities.

Page 2: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Understand Original Medicare

Discover the benefits of Providence Medicare Advantage Plans

Find out if you are eligible

Get started and find the right plan for you

Medicare is an amazing program with many benefits, but it can be confusing. Thankfully, you don’t have to figure it out alone.

This guide outlines everything you need to:

What’s the deal with Medicare?

Page 3: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services
Page 4: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services
Page 5: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Medicare is a federal government program that provides health care coverage for most Americans usually of retirement age.

It sounds simple, and it can be, but there are layers to Medicare. It’s a good idea to understand your options so that you can put together a plan that will work best for you.

What is Medicare?

Page 6: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Original Medicare is a combination of two programs, Part A

and Part B. If you are eligible, these are the plans in which

you are automatically enrolled. Part D and Medigap are

optional add-ons — private insurance plans that fill some of

the gaps in the standard government option.

Original Medicare is a social safety net that covers your

basics — but not all your bases. Coverage restrictions,

provider availability, and out-of-pocket expenses can really

limit your choices, and it generally doesn't cover preventive

dental or eye health at all.

Fortunately, Medicare Advantage plan offers many turn-

key options that extend the power of Original Medicare and

include additional coverage, convenience, and benefits that

you want from your health insurance.

Original Medicare and its parts

What do you really want from your health care?

The traditional Medicare options

Page 7: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Optional, private add-on plans — Part D and Medigap

Inpatient hospital services

Skilled nursing facility care

Hospice care

Home health care

Brand-name drugs

Generic drugs

Outpatient services

Doctor visits

Outpatient lab tests and X-rays

Various additional health care costs

Government programs — Part A and Part B

Original Medicare Part A is Government

issued hospital insurance. It usually

comes at no cost if you or your spouse

paid Medicare taxes for at least 10 years.

Medicare Part A and Part B don’t

cover prescription drugs, so private

insurers partner with Medicare to

offer prescription drug coverage with

varying costs and plan options.

Medigap is Medicare supplemental

health insurance that is sold by private

insurance companies. Medigap helps

pay some health care costs that aren’t

covered under Original Medicare.*

*Medigap cannot be used with Medicare Part C Medicare Advantage plans.

Medigap

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D

B

Original Medicare Part B is Government

issued medical insurance. You pay for

it based on your income, and is usually

deducted from your Social Security

check (or Railroad Pension).

Page 8: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Medicare Advantage — Part C — is a program offered by Providence

Medicare Advantage Plans (and other private insurers) in partnership

with the government. Original Medicare only pays for certain medical

services. With a Medicare Advantage plan, you get Medicare Part A

and B benefits plus additional coverage and services offered by a

private insurance provider. Sign up for a Medicare Advantage plan at

the same time you enroll in original Medicare. You will still pay your

Part B premium, but your coverage with Medicare Advantage will be

more comprehensive.

Options and costs vary but include earned Plan A with the regular Plan B cost. *There are lots of Medicare Advantage plans on the market; not all cover these things.

Medicare Advantage(a.k.a. Part C)

The simpler, more complete option

Part A and B benefits

Eye and dental care*

Prescription drugs*

Other benefit options*

Page 9: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

If you do get a Medicare Advantage plan, remember to tell your health providers. There are key differences in access and coverage between Original Medicare and Medicare Advantage.

Greater access to doctorsA lot of doctors are closed to Original Medicare patients, yet open to Providence Medicare Advantage Plans members.

Medicare Advantage plans give you more

Prescription drug coverageMost Medicare Advantage Plans include pharmacy services that cover generic and brand name prescription drugs.

Guaranteed coverage standardThe Centers for Medicare & Medicaid Services (CMS) determines the minimum coverage limits that all plans must meet at least the same level of coverage as Original Medicare.

Out-of-pocket limitWith Original Medicare, there is no cap on the expenses you pay for. Medicare Advantage plans have a yearly out-of-pocket maximum for all covered expenses.

Affordable dental plansOn top of the benefits included with Providence Medicare Advantage Plans, there are affordable add-on dental plans, and some plans include preventive dental.

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Page 10: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

There are many reasons to choose a Medicare Advantage plan over Original Medicare. At Providence Medicare Advantage Plans we make the choice even easier.

Put the advantage in Medicare Advantage

More reasons to believe

Page 11: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

A history of excellenceOver 160 years of caregiving has driven us to find the best ways to help the most people.

Options and more optionsYou’ll find the perfect fit among a variety of plans, each with different benefits and cost structures.

We make it easyIf you're an existing Providence Health Plan member, you can keep your existing providers while maintaining access to your complete medical history plus all of our great wellness content and digital tools.

A legacy of innovationWe are constantly adding enriching new services, like no-cost fitness center memberships and Providence Express Care Virtual visits, to improve convenience and contribute to your quality of life.

In-network providers galoreWe work with thousands of in-network providers, giving you access to the care you need, where you need it.

Community championsWe’re not-for-profit, based in the Pacific Northwest, and committed to improving the health and well-being of our community. Membership with Providence Medicare Advantage Plans contributes to the greater good.

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The Providence advantages

Page 12: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Want to learn more?

Come to a free Medicare meeting

Join a Providence Medicare Advantage Plans get-

together at a restaurant or other community space

near you. Learn the difference between plans, find

options that work for you, and get answers. We

can even help you enroll in a Providence Medicare

Advantage plan.

Let us come to you

We’d be happy to meet in person for a free

Medicare consultation at a place and time that

works for you.

Pick up the phone

1-800-457-60641-503-574-5551 (TTY: 711) 8 a.m. to 8 p.m. PST, 7 days a week Oct. 1-Dec.7;

Monday-Friday Dec. 8-Sept. 30

Go to our website

mytrueplans.com

Here's how to connect with us to find the best plan for you.

Page 13: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Just three steps to sign up

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Make sure you're eligibleTo qualify, you must be a U.S. citizen or permanent legal resident for at least 5 years and, usually, be 65 or older.

When you turn 65, if you are receiving Social Security or a Railroad Retirement Pension, you are automatically enrolled in Original Medicare.

If you don’t qualify for automatic enrollment, you should enroll when you’re first eligible to avoid any late penalties that may occur.

If you’re under 65, you might qualify in one of these situations:

You’re permanently disabled and receive disability benefits for at least 24 months — which doesn’t have to be consecutive

You have end-stage renal disease (ESRD)

You have Lou Gehrig’s disease (ALS)

Enroll in Part A and Part BMedicare automatically enrolls you in Medicare Part A and Part B if you are age 65 and getting Social Security or a Railroad Retirement Pension. If you do not qualify for automatic enrollment, you may need to enroll yourself. The enrollment window is three months before your 65th birthday, the month of your birthday, and three months after. If possible, try to enroll when you are first eligible, or you may pay a penalty. You can check your status online at www.mymedicare.gov or call 1-800-633-4227.

Go to our websiteVisit mytrueplans.com and follow the steps of our easy guide to sign up. Based on your location and your preferences, we will help you select a Providence Medicare Advantage plan that meets your needs. Easy peasy.

Page 14: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Questions? Here's a little notepad for you.

Page 15: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Out-of-network/non-contracted providers are under no obligation to treat Providence Medicare Advantage Plans members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

State health insurance assistance programs are state-run programs that get money from the federal government to provide free local health insurance counseling to people with Medicare.

A sales advisor will be present with information and applications. For accommodation of persons with special needs at sales meetings, call 1-800-457-6064 or 1-503-574-5551 (TTY: 711).

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

Medicare Information 1-800 MEDICARE (1-800-633-4227) 24 hours a day, seven days a week TTY/TDD users should call 1-877-486-2048

Social Security Administration 1-800-772-1213 7 a.m. to 7 p.m., Monday through Friday TTY/TDD users should call 1-800-325-0778

OregonSenior Health Insurance Benefits Assistance Program (SHIBA) 1-800-722-4134 TTY/TDD users should call 711 or 1-800-735-2900

Washington Statewide Health Insurance Benefits Advisors (SHIBA) 1-800-562-6900 TTY/TDD users should call 1-360-586-0241

Providence Medicare Advantage Plans Sales TeamP.O. Box 5548, Portland, OR 97228-5548

Page 16: Simplifying Medicare - Providence Medicare Advantage Plans€¦ · services. With a Medicare Advantage plan, you get Medicare Part A and B benefits plus additional coverage and services

Providence Health Plan and Providence Health Assurance comply with applicable Federal civil rights laws

and do not discriminate on the basis of race, color, national origin, age, disability, or sex.

© 2019 Providence Health Plan. All rights reserved. H9047_2020PHA84_M

Talk with a customer service team member

1-503-574-5551 or 1-800-457-6064 (TTY: 711) 8 a.m. to 8 p.m. PST, 7 days a week Oct. 1-Dec.7;

Monday-Friday Dec. 8-Sept. 30

mytrueplans.com

Our ValuesCompassion | Dignity | Justice | Excellence | Integrity

Our MissionAs expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.


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