Providence Medicare Plans Common Questions

• Who is eligible?
• What do Providence Medicare Plans cover?
• What are some of the special features?
• What are "Managed Care" Plans — what does that mean?
• Do I get to pick my own doctor?
• What happens after I join?
• Help is here

You can enroll in a Providence Health Plan 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 Choice and Providence Medicare Extra are offered. See the Oregon and Clark County, Washington, map (PDF 52kb).
• 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 Plan will be responsible for the costs except in emergent or urgent care situations or for out-of-area renal dialysis. Some exceptions apply to members of Providence Medicare Choice who choose to use their point of service benefit. Please contact plan for details or refer 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 Plan's contract with CMS is renewed annually and that the availability of coverage beyond the end of the current contract year is not guaranteed.

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We cover everything that Original Medicare covers and more. We can be your complete health plan. For details about benefits, please call the Providence Medicare Plans sales team.

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Here are some of our benefits that may interest you most:

• We cover emergency and urgent care worldwide.
• We cover routine vision exams.
• We cover routine physicals and testing.

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"Managed care" is provided by doctors and hospitals who focus on prevention and quality. For Providence Medicare Plans members, this means:

• Your benefits cover check-ups, which help you and your doctor anticipate possible health problems or spot any early warning signs.
• We offer a free 24-hour consulting nurse telephone service to answer your health questions.
• We send you a free newsletter full of articles about the health issues that concern you.

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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." You must select a primary care provider in our network. 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 device (For the hearing impaired) call 503-574-8702 or 1-888-244-6642.

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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.

We'll include a list of 'Welcome Meetings' in your area. We hope you will come to one of the meetings to meet us, learn more about your new coverage, and let us answer your questions. 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 Health Plan. 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 Plans sales team.

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If you need enrollment help or want more information about a Providence Medicare Plans, please call the phone numbers listed on this page.

Providence Health Plan is a health plan with a Medicare Advantage contract. 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

Providence Medicare Plans Medicare Prescription Drug Benefits are only available to members of the Providence Medicare Plans.

If you are already enrolled in a Medicare Advantage plan, you must receive your Medicare Prescription Drug Benefit through that plan.

You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party.

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