Community Focus

Medicare 101: What You Need to Know Before Making a Medicare Decision

28 October 2024

For members who are currently or will soon be eligible for Medicare, there are many important details you should consider when selecting a Medicare plan.

If you are a member who is in the process of deciding which Medicare plan is right for you, Providence is here to offer guidance to help you make that decision. Below is some general information on Medicare and some helpful tips and resources for you to consider when selecting Medicare coverage that best fits your needs.

What is Medicare?

Medicare is the federal health insurance program for people 65 and over. It is also available to individuals under the age of 65 with disabilities or certain chronic conditions, such as ESRD (End Stage Renal Disease), and have been receiving Social Security Disability Insurance (SSDI) benefits for at least two years.

What are the differences between the various Medicare Parts and supplemental plans?

There are several types of Medicare coverage, but the most popular options include:

• Medicare Advantage: Medicare Advantage covers hospital bills and doctor visits and oftentimes prescription drugs. Also, insurers can add coverage for items not included in traditional Medicare, such as over-the-counter medication, gym memberships, enhanced vision and dental coverage, non-emergent medical transportation, hearing aids, and other services that you may need.

• Medicare Supplement: Medicare Supplement (also known as Medigap) helps to fill "gaps" in traditional Medicare. While traditional Medicare pays for many medical costs, there are out of pocket expenses such as copays and deductibles that you pay. Medicare Supplement can help pay some of those remaining health care costs, including copayments, coinsurance, and deductibles.

• Medicare Part D: Medicare Part D, (also known as the Medicare prescription drug benefit), is a separate, optional component of the Medicare program and is included with most Medicare Advantage Plans. Medicare Part D helps Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums. 

How do Medicare Advantage plans work? What benefits do they have?

Providence Medicare Advantage plans cover everything traditional Medicare includes and may offer additional services not covered by traditional Medicare. Medicare Advantage Plans are beneficial as they typically have a network of doctors they contract with, meaning that while some providers are closed to traditional Medicare patients, they will accept patients who are on a Medicare Advantage plan. 

Medicare Advantage Plans also typically include a Part D prescription drug plan. This is useful as you don’t have to purchase a standalone Part D plan, and by having Medical and Part D coverage, you will experience coordinated care that is administered by the same company.

How do Medicare Supplement plans work? What benefits do they have?

Through a Providence Medicare Supplement plan, you can choose any Medicare-accepting provider and reduce your out-of-pocket costs, whether it is with a primary care physician or specialty clinics nationwide with no referrals needed.

Certain Medicare Supplement plans also include extended coverage for overseas travel. As a Providence Medicare Supplement member, you can also take advantage of our 24/7 nurse hotline, discounts on hearing aids and a free gym membership.

Medicare Supplement plans can help cover some expenses not paid by Medicare Parts A and B alone. Providence’s plans are designed to help with some of the out-of-pocket costs associated with Medicare, such as deductibles, co-insurance, and copayments. This is beneficial as it makes costs more predictable and more affordable. Providence Medicare Supplement plans are guaranteed to be renewed every year, as long as the member has and pays for a Medicare Part A or B.

How can I enroll in a Plan?

Medicare Advantage:
You must have Medicare Part A and B to enroll in a Medicare Advantage plan and the beneficiary must reside in Providence’s geographic service area.

You also have multiple options to sign up for a Medicare Advantage plan. You can securely enroll in a plan online, by phone through our Medicare Advantage Plans Sales team at 503-574-7756 or 888-804-5148 (TTY: 711), or by mail by completing a paper enrollment form and mailing to:

Providence Medicare Advantage Plans
P.O. Box 5548
Portland, OR 97228-5548
You can also fax it to 503-574-8653

Medicare Supplement:
If you want to enroll in a Medicare Supplement plan, you can enroll online, or you can contact our Medicare Supplement Sales team at 1-888-231-9287.

What if I have additional questions?

You can download our Simplifying Medicare Guide at ProvidenceHealthAssurance.com/guide for additional information. Our Medicare experts are available 8 a.m. to 8 p.m. (Pacific Time), Monday through Friday and can be reached at [503-574-5199 or 1-866-366-0540 (TTY: 711)].

There are also several free Medicare 101 webinars occurring throughout the month of October. To view the webinar dates and to learn more about what will be featured in the webinars, please visit  ProvidenceHealthAssurance.com/medicare101.

Stay tuned for more Medicare-related tips and resources from Providence in the coming months. To learn more about Medicare plans and resources available from Providence, please visit: https://www.providencehealthplan.com/medicare.

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