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Medicare
FAQ
We recommend Regence Blue Cross Blue Shield
MedAdvantage Plans
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Q. |
What is
Medicare? How does it work? |
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A. |
Medicare is a federal health
care program, managed by the Centers for
Medicare & Medicaid Services (CMS), which
provides health insurance to retired
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 $1,068 deductible for
hospital stays up to 60 days, with
additional copays required for each stay
longer than 60 days. |
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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 2009
Medicare Part B beneficiary premium is
$96.40 per month. Medicare Part B has a $135
annual deductible, with 20% coinsurance
after deductible is met.
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Q. |
What is a Medicare
Advantage Plan? |
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A. |
Medicare Advantage is the
name for a few different types of plans that
contract with the federal government.
Medicare Advantage plans include Medicare
Managed Care Plan (HMO), Medicare Preferred
Provider Organization (PPO), Medicare
Private Fee-for-Service plan (PFFS) and
Medicare Cost and other specialty plans.
Essentially, these plans reduce
out-of-pocket expenses and provide greater
coverage than traditional Medicare alone,
providing 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 is a PPO with a
Medicare Advantage contract.
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Q. |
Who is eligible? |
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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 plan as compared to an
HMO plan or a Medicare Supplement? |
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A. |
There are three types of health care plans
that help protect you 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 receive
your care and services in-network.
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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 that replaces
Medicare.
Medicare Supplement plans are secondary
policies to Medicare. They do not have a
network of providers and usually cost more
per month than HMOs and PPOs. Most Medicare
Supplement plans typically 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.
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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? |
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A. |
With a Regence MedAdvantage 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 plans.
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Q. |
What dental coverage is
included? |
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A. |
With Regence MedAdvantage, Regence
MedAdvantage + Rx Classic and Regence
MedAdvantage + Rx Enhanced, 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. This benefit is not available with
Regence MedAdvantage + Rx Core. See the
(501k PDF) Summary of Benefits
for limitations.
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Q. |
What vision coverage is
included? |
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A. |
With Regence MedAdvantage, Regence
MedAdvantage + Rx Classic and Regence
MedAdvantage + Rx Enhanced, members are
eligible for routine vision exams once every
two years for in-network services. There is
a $10 copay per visit for utilizing
in-network services. Vision hardware is
covered up to $100 every two years. This
coverage is not available with Regence
MedAdvantage + Rx Core.
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Q. |
What about hearing services? |
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A. |
For Medicare-covered hearing exams
(diagnostic hearing exams), there is a $10
copay per visit with Regence MedAdvantage,
Regence MedAdvantage + Rx Classic and
Regence MedAdvantage + Rx Enhanced for
in-network services. A $25 copay applies to
Regence MedAdvantage + Rx Core for
in-network services.
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Q. |
Are prescription drugs
covered? |
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A. |
Yes, if you choose Regence MedAdvantage + Rx
Core, Regence MedAdvantage + Rx Classic and
Regence MedAdvantage + Rx Enhanced. You pay
a share of your prescription medication
costs (copays or coinsurance), and your plan
pays a share.
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Q. |
What if I don't want
prescription drug coverage?
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A. |
If you don't want or need prescription drug
coverage, you can choose just the Regence
MedAdvantage 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 by May
15, 2006, there is a 1% premium penalty for
every month you could have enrolled but
didn't.
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Q. |
What other services does
Regence MedAdvantage provide? |
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A. |
Access to discount programs such as vision
care services, hearing care services,
discounts at fitness clubs and discounts on
prescription medications.
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Q. |
Are members locked into
Regence MedAdvantage for a specific length
of time? |
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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 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
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.
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?
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A. |
Individuals on limited
income, applying for prescription drug plans
(such as Regence MedAdvantage + Rx), may
qualify for reduced premiums and/or
copayments. |
