| Q. |
What is Medicare? How does it work? |
| A. |
Medicare is a federal health care program, managed by
the Centers for Medicare & Medicaid Services (CMS), which provides health insurance to eligible individuals regardless of medical condition and to certain people with disabilities. Original Medicare is a fee-for-service
plan with two components, Medicare Part A and Medicare Part B.
Medicare Part A provides coverage for hospital bills (inpatient hospital
care, hospice care, and home health care). This is financed by payroll
taxes, with no premium to beneficiaries who have at least 40 quarters of
Medicare-covered employment. The beneficiary pays a $1,100 deductible for hospital stays
up to 60 days, with additional copays required for stays longer than 60
days.
Medicare Part B provides coverage for doctor bills (physician care as an
inpatient at a hospital, at a doctor's office, or as an outpatient at a
hospital or other health care facility) laboratory tests, physical therapy,
and ambulance service. The 2010 Medicare
Part B beneficiary premium is $110.50 per month. Medicare Part B has a $155 annual deductible, with coinsurance amounts for services after deductible is met.
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| Q. |
What is a Medicare Advantage Plan? |
| A. |
Medicare Advantage is the name for a few different types
of plans that contract with the federal government. Medicare Advantage
plans include a Medicare Managed Care Plan (HMO), Medicare Preferred Provider
Organization (PPO), Medicare Private Fee-for-Service plan (PFFS) and Medicare
Specialty Plans. Essentially, these plans reduce out-of-pocket expenses and provide greater
coverage.
These plans provide all the benefits of Medicare Parts A and B, plus additional
benefits. The beneficiary continues to pay the Medicare Part B premium
as well as any additional premium charged by the Medicare Advantage plan.
Regence MedAdvantage (PPO) is a health plan with a Medicare contract.
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| Q. |
Who is eligible? |
| A. |
Potential members need to be at least 65 years old or
qualified as disabled by Medicare. They must have Medicare Parts A and B,
live within the plan's service area, and not have end-stage renal disease (ESRD).
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| Q. |
Why should you consider a Regence MedAdvantage (PPO) plan as
compared to an HMO plan or a Medicare Supplement? |
| A. |
There are three types of health care plans that can
protect from unexpected costs. Health Maintenance Organizations (HMOs)
are managed care plans that require the member to use only contracted doctors
and hospitals and typically referrals are required to see specialists.
Preferred Provider Organizations (PPOs) also have a contracted
network of providers, but members can still see any provider that accepts Medicare patients and
receive coverage. The plan pays more if you stay in-network.
- HMOs and PPOs offer increased benefits over Original Medicare such as
physicals and vision care. HMOs and PPOs
roll original Medicare benefits and supplemental benefits into one
plan the replaces Medicare.
Medicare Supplement (Medigap) plans are secondary policies to Medicare. They
do not have a network of providers and usually cost more than HMOs
and PPOs. Most Medicare Supplement plans do not offer coverage for
physicals or vision care.
- Medicare Supplement (Medigap) plans help reduce your out-of-pocket medical
expenses for unexpected medical costs associated with Medicare
deductibles and coinsurance. This coverage can include the Part
A and Part B deductibles and coinsurance, the skilled nursing
facility coinsurance, as well as other benefits.
- There are twelve standardized
Medigap plans, labeled “A” through “L” each
with different sets of benefits and premiums. Plan A has basic
supplemental benefits, Plan J the most comprehensive. All plans include
Basic benefits but not all insurance companies offer all Supplement plans.
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| Q. |
What providers can I see? |
| A. |
With a Regence MedAdvantage (PPO) plan members are free to see any contracted provider
accepting Medicare patients. Our provider networks offer many qualified providers to choose
from. When a member chooses to see a provider that is not in our network, the member's share of the costs will be greater. Members are encouraged to see in-network providers to receive the best benefit from the plan and lower out-of-pocket costs. The opportunity for members to choose who provides their care is one of the advantages of our Regence MedAdvantage (PPO) plans.
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| Q. |
What happens if I’m traveling and am outside the service
area for an extended period of time? |
| A. |
Regence MedAdvantage (PPO) plans will cover you for medical emergencies
anywhere in the world. There’s a copay for services in a hospital emergency room.
For non-urgent or routine care that is out-of-network, you’ll pay the copay specified by your plan.
Nationwide, in-network coverage is available in areas where other Blue Cross and
Blue Shield plans have a Medicare Advantage PPO plan, have contracted Medicare
Advantage providers and are participating with the Blue Cross and Blue Shield
Association in this travel program.
Part D prescription drug coverage is not available outside the United States and
its territories.
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| Q. |
How do you find in-network providers? |
| A. |
You can check online to see if a provider is on our network, or request a printed version of our provider directory.
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| Q. |
What is the dental coverage? |
| A. |
A member can go to any dentist and is covered
up to $500 annually for routine preventive dental services such as cleanings, x-rays
and exams. See the Summary of Benefits for limitations.
|
| Q. |
Is vision coverage included? |
| A. |
With all of our Regence MedAdvantage (PPO) plans members are eligible for routine vision exams once every two years. There is a $10 copay for utilizing in-network benefits with Regence MedAdvantage + Rx Enhanced (PPO) and Regence MedAdvantage (PPO); there is a $25 copay for utilizing in-network benefits with Regence MedAdvantage+ Rx Classic (PPO). Vision hardware is covered up to $100 every two years with Regence MedAdvantage + Rx Classic (PPO) and is covered up to $200 every two years with Regence MedAdvantage + Rx Enhanced (PPO) and Regence MedAdvantage (PPO).
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| Q. |
What about hearing services? |
| A. |
For Medicare-covered hearing exams (diagnostic hearing exams), there is
a $10 copay for in-network services with Regence MedAdvantage (PPO) and Regence MedAdvantage + Rx Enhanced (PPO). A $25 copay applies to Regence MedAdvantage + Rx Classic (PPO) for in-network services.
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| Q. |
Are prescription drugs covered? |
| A. |
Yes, if you choose Regence MedAdvantage + Rx Enhanced (PPO) and Regence MedAdvantage + Rx Classic (PPO). You pay a share of your prescription
medication costs (copays or coinsurance), and your plan pays a share. In addition, Regence MedAdvantage + Rx Classic (PPO) has a $255 deductible.
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| Q. |
What if I don’t want prescription drug coverage? |
| A. |
If you don’t want or need prescription drug coverage, you can choose
just the Regence MedAdvantage (PPO) plan. Please note that if you were Medicare eligible, do not have creditable prescription drug coverage and didn't choose a Medicare
Part D plan, there is a Medicare-imposed
premium penalty for every month you could have enrolled but didn't.
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| Q. |
What other services does Regence MedAdvantage (PPO) provide? |
| A. |
Access to discount programs such as vision care services,
hearing care services and discounts at fitness clubs.
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| Q. |
Are members locked into Regence MedAdvantage (PPO) for a specific length of
time? |
| A. |
Yes, most people will be required to stay with the same plan for one year. For people currently on Medicare, the Annual Election Period (AEP) is November 15 to December 31. During this time, enroll in a Regence MedAdvantage (PPO) plan and your coverage will start January 1. If you are already on a Medicare Advantage PPO, HMO or PFFS plan you can still switch to a Regence MedAdvantage (PPO) plan, or cancel your plan, during this time.
If you are currently on Original Medicare or a Medicare Advantage plan you also have an Open Enrollment Period (OEP) from January 1 to March 31. During this time you can switch Medicare Advantage plans or cancel your plan and go back to Original Medicare Part A and B. Some limitations may apply.
Once you enroll in our plan it is effective until January 1 of the following year. Your next opportunity to change or enroll comes on November 15 each year for a January 1 effective date.
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| Q. |
What help is available for people with limited income? |
| A. |
Individuals on limited income, applying for prescription drug plans (such as Regence MedAdvantage + Rx (PPO) plans), may qualify for reduced premiums, copays and/or coinsurance. To find out more about eligibility and to apply, go to www.socialsecurity.gov, or call the Social Security Administration at 1 (800) 772-1213. TTY users can call 1 (800) 325-0778.
I Have Limited Income What Should I Do? (PDF) |
