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.

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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.

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Medicare Part A is funded through payroll taxes. Most individuals don't have a Part A monthly premium.

For Part B, there is a monthly premium that is adjusted from year to year. For most people who are new to Medicare in 2011, the Part B premium is $115.40 per individual per month. However, if your annual modified adjusted gross income in 2010 was more than $85,000 (filing singly) or more than $170,000 (filing jointly), your Part B premium is higher. Contact the Social Security Administration if you have questions about higher Part B premiums: 1-800-772-1213 (TTY 1-800-325-0778) or www.ssa.gov.

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• 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.

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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. See the Oregon and Clark County, Washington, map (PDF).
• 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 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 or Providence Medicare Open (PPO) members who can see any Medicare provider without a referral. 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 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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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. If you take prescription drugs, review Medicare plan drug lists to see if your prescriptions are covered.
3. Go to the Web sites of the health insurance companies on your list, and review information about premiums and coverage.
4. 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.
5. 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.

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Call the health plan or go to its website to complete and submit an application during one of the following time frames:

• 65th birthday – You can submit an application up to three months before your Medicare effective date, during the month of your effective date or up to three months after your effective date.
• Annual enrollment – You can enroll in and/or change plans from Nov. 15 to Dec. 31, 2010, for an effective date of Jan. 1, 2011.
• Loss of group coverage – If you are losing your group coverage, we suggest that you submit an application at least one month before losing your coverage, or contact your new plan of choice.
• Disability - If you get Medicare due to a disability, you can join three months before and three months after your 25th month of disability.

There are other situations that allow you to enroll outside these time frames. Contact the health plan for more information.

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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." If you choose a Providence Medicare Extra or a Providence Medicare Choice plan 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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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.

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Medicare Part D is prescription drug insurance available to you when you turn 65. It is a voluntary program, which means you aren't required to enroll and you have the option to enroll in the future.

However, it is important to note that if you are eligible for Medicare and are not enrolled in a Part D plan, or a plan that is considered creditable coverage, you could be subject to a penalty.

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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.

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A Medigap or supplement plan helps fill the gap between Medicare coverage and the total cost you are charged for a service. You pay a separate premium for this type of plan. Medicare is the primary payer, while the supplement plan is the secondary payer.

A Medicare Advantage plan adds benefits not covered by Medicare and charges a premium for the additional coverage. Medicare Advantage pays primary and virtually handles all of the paperwork for you.

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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 Advantage Plans sales team locally at 503-574-5551 or toll free at 1-800-457-6064 from 8 a.m. to 8 p.m., seven days a week.

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To keep informed on health care reform and how it will affect you, visit the Providence reform site to stay up-to-date on plan decisions and health care reform updates.

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

Providence Health Plan is a health plan with a Medicare 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
• 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 the Providence Medicare Advantage Plans.

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