If your employer has 20 or more employees, they are required to provide credible coverage.

If they have less than 20 employees, talk with your employer’s benefits administrator to see if they have provide credible coverage. If not, you may need to sign up for Medicare Parts A and B when you turn 65. Medicare would become your primary coverage and your employer coverage would pay secondary to Medicare. Talk with your employer’s benefits administrator or contact us to discuss your specific situation.

Your employer drug coverage must be at least as good as what Part D coverage provides. If your employer’s drug coverage isn’t creditable, you’ll need to enroll in Part D during your Initial Enrollment Period to avoid the Part D late enrollment penalty. You’ll also need to get either Part A or Part B in order to get Part D. 

To keep your employer’s coverage without penalty, you must have creditable Rx coverage. Ask your employer’s benefits administrator if your drug coverage meets CMS’s standards. 

If you are older than 65 and three months, you'll have a Special Enrollment Period when your group coverage ends. After the month you experience a qualifying event, like retirement or a change to your group benefits, you have 2 months to enroll in Providence Medicare Advantage. Even though you have 8 months to sign up for Original Medicare, to get Medicare Advantage you’ll need to be sure to enroll within those first 2 months.

If you plan to work past 65 and delay enrolling in Medicare, stop making HSA contributions at least six months prior to your Medicare effective date to avoid a penalty. Once you’re enrolled in any part of Medicare, you can no longer contribute to your HSA. However, you can use your HSA to cover qualified medical expenses including various Medicare premiums, deductibles and copays.

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.

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.

Information taken from cms.gov.

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 on the Medicare.gov website.

Information taken from cms.gov.

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 except for 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.

Information taken from cms.gov.

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 already has Part D coverage, you cannot enroll in a standalone Part D plan as it would automatically disenroll you from your Medicare Advantage Plan (Part C). 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.

If you qualify for both Medicare and Medicaid, a Dual Special Needs Plan (D-SNP) coordinates your Medicare, Medicaid (also known as the Oregon Health Plan), and Part D coverage to give you extra benefits at no cost. Learn more here.

If you are unemployed, meet certain income requirements, and have limited financial resources, you may be eligible for the Extra Help program. Extra Help, also known as Low Income Subsidy (LIS), is a special program that lowers prescription drug and Part D costs. Call 503-574-8416 to see if you qualify or visit here to learn more.

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.

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

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 is 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 open enrollment period is from January 1st to March 31st. During this time, current 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.

Medicare can be confusing. Here's our Medicare Glossary to help you understand the terms.

In some cases, your coverage may not coordinate benefits with Medicare Part A, Part B, or Part A and B. If you wish to cancel your other coverage and recurring payments as well as ensure your dependents still have the coverage they need, please refer to the document below.

Transitioning to Medicare Advantage (PDF)

For assistance please contact 888-816-1300 (TTY: 711) Monday through Friday 8 a.m. to 5 p.m. (Pacific Time).

Let’s compare:

HMO-POS

• Great choice if you love to travel
• Has benefits for both in-network and out-of-network providers
• Benefits are stronger if you stay in-network
• Costs more than HMO plans because of larger network

HMO

• Good option if travel isn’t as important
• Costs less than HMO-POS plans
• Out-of-network providers are not covered

Whatever you choose, just remember that not all HMOs are created equal. Some have narrow networks with specific providers, whereas the Providence network gives you access to thousands of providers nationwide.