Medicare Basics

What is Medicare? An Overview

Medicare is a program administered by the Federal Government that provides insurance options for individuals age 65 or older, or who qualify due to certain disabilities or medical conditions. Learn more.

Most people automatically receive one part of Medicare—Medicare Part A—when they become eligible. However, there is more to Medicare than just Part A. The following information will help get you started on the road to understanding the different parts of Medicare and figuring out which options are best for you, your budget, and your health needs.

Together, Medicare Parts A and B are typically known as Original Medicare. Most people have both A and B coverage.

Part A: Hospital Care

When you become Medicare eligible, you are usually automatically enrolled in Medicare Part A.

Part A focuses on covering inpatient expenses (the costs that are incurred when you have to stay at least one night in a medical facility like a hospital). These costs typically include:

• Inpatient hospital care
• Inpatient stays in most skilled nursing facilities
• Hospice and home health services

Part A does not cover all inpatient expenses. You will be responsible for paying for some costs before your benefits apply (your deductible) and for a certain amount of costs after the deductible is met.

Part A is administered by the government. To find out more about Medicare Part A, visit www.medicare.gov.

Part B: Doctor Visits

Once you are Medicare eligible, you can choose to enroll in Medicare Part B.

Part B focuses on covering doctor visits—the costs that are incurred when you visit a doctor and have medical tests performed in a physician’s office or hospital. This coverage typically includes:

• Doctor and clinical lab services
• Outpatient and preventive care
• Screenings, surgical fees and supplies
• Physical and occupational therapy

If you enroll in Part B, you will be responsible for some costs:

• You will pay a monthly premium, which is automatically deducted from your Social Security payment.
• You will be responsible for paying some costs out of pocket until you meet your deductible.
• You will be responsible for paying a certain percentage of costs for the doctor’s visits and medical services you receive (your coinsurance).

Part B is administered by the federal government. To find out more about Medicare Part B, including costs and how to enroll, visit http://www.medicare.gov.

Part C (Medicare Advantage): Additional benefits, assured access to providers

Medicare Part C, or Medicare Advantage, is an alternative that covers the benefits of both Medicare Parts A and B, plus additional, richer benefits.

Medicare Advantage plans are administered by private insurance companies like Regence. When you choose a Medicare Advantage Plan, you get the same coverage as Parts A and B, plus coverage for some benefits Part A and B alone do not cover. These additional benefits vary amongst individual carriers.

Medicare Advantage PPO plans give you guaranteed access to a wide range of physicians and other health care professionals to provide you with the best care. With Original Medicare, you can go to any provider who accepts Medicare.

If you purchase a Medicare Advantage Plan, you pay a monthly premium and a percentage of some costs. You will also be required to continue paying for your Part B premium.

Regence offers three Medicare Advantage Plan options. For more information, click here.

about Regence Medicare Advantage PPO plans at a Medicare seminar.

Medicare Part D: Prescription drugs

Medicare Part D is an optional plan administered by private insurance companies like Regence that covers prescription medications.

If you enroll in Medicare Part A, B and/or a Medigap plan, you can purchase Part D as a stand-alone product to help cover your prescription medication.

If you purchase a Medicare Advantage plan, you can choose whether you want a plan that includes Part D prescription coverage or not (if you want to purchase a Medicare Advantage plan and have prescription coverage, you must choose a Medicare Advantage plan with prescription coverage built into it).

If you purchase Part D coverage, you are responsible for paying a monthly premium. You also pay either a copay or a percentage of the cost of drugs according to your plan formulary.

Some Part D options also require you to meet a deductible before your benefits apply.

about your Part D options.

Medigap: Filling in the gaps

Medigap (or Medicare Supplement) plans are generally the richest coverage available to the Medicare-eligible.

Medigap plans are administered by private insurance companies and give you coverage for things that Part A and Part B alone do not cover, like your deductibles and coinsurance.

A person must be enrolled in Part A and Part B of Medicare before they can enroll in a Medigap plan.

Medigap plans do not include prescription drug coverage. You can, however, purchase stand-alone Medicare Part D coverage to cover these costs.

Regence offers Medigap plans. Click here for more information.

If you purchase a Medigap plan, you pay a monthly premium. Many Medigap plans have lower out-of-pocket costs than other Medicare options.

Why Regence?

Your health is the most important asset you have. It's vitally important that you choose a Medicare carrier that has knowledge, resources and experience. Regence has more than 90 years of experience, excellent customer service, and a wide selection of products to fit your needs and budget.

Why choose a Medicare plan offered by Regence?

You want tools that help you stay healthy.

• We are as invested in your health as you are. That’s why many Regence Medicare plans give you access to special programs that help you make the most of your health, like access to 24-hour nurse lines, online tools and special educational programs about chronic health conditions like diabetes.

You want coverage to meet your needs

• Original Medicare covers some of your medical costs, but not all of them. Opting for a Regence Medicare Advantage Plan, Medicare Script Part D Prescription Drug Plan or Medigap Supplement means you get more coverage and support. Depending on the plan you choose, you’ll enjoy things like lower deductibles and copays, extra features like routine vision and preventive dental coverage, access to a wider network of medical providers, and out-of-pocket maximums to help manage your costs. Ready to find out more about this coverage? Learn more.

You want a helping hand.

• When you choose Medicare coverage through Regence, you get access to an excellent customer service team. Whether you have a question about your coverage, want help sorting out a medical bill or just need somebody to help you figure out which plan option fits your needs best, Regence’s in-house customer service professionals are available to lend an ear. And you won’t spend all day waiting for an answer.

You want somebody who knows the system.

• Regence started out as a member-founded cooperative in 1917 as Pierce County Medical. Since then, we’ve watched our service area and membership grow exponentially, but have never forgotten the lessons we've learned along the way. We look forward to sharing our experience with you.

Important Dates

When Can I Enroll?

Under My Current Coverage, I…	Annual Election Period (AEP) Oct. 15 – Dec. 7	Medicare Annual Disenrollment Period Jan. 1 – Feb. 14
…am on Parts A and B only or a Medicare supplement plan, but not a Medicare Advantage plan or a Part D prescription drug plan.	You can enroll in a Medicare Advantage plan or a Medicare Part D stand-alone prescription drug plan. Coverage takes effect Jan. 1.	You cannot enroll in a Medicare Advantage Plan or stand-alone Part D plan at this time.
…am on a Medicare Advantage plan without Part D prescription drug coverage.	You can switch to a Medicare Advantage plan that includes Part D coverage, or to a different Medicare Advantage plan without Part D coverage. You can also enroll in a Medicare Part D stand-alone plan. Coverage takes effect Jan. 1.	You can disenroll from your Medicare Advantage plan and return to Original Medicare. You are also allowed to purchase a stand-alone Part D plan if you are making this change.
…am on a Medicare Advantage plan with Part D prescription drug coverage.	You can switch to a different Medicare Advantage plan that includes Part D coverage, change to a Medicare Advantage plan without Part D coverage, or disenroll from your Medicare Advantage plan and join a stand-alone Part D plan. Coverage takes effect Jan. 1.	You can disenroll from your Medicare Advantage plan and return to Original Medicare. You are also allowed to purchase a stand-alone Part D plan if you are making this change.
…have Original Medicare and a stand-alone Part D prescription drug plan.	You can elect a different stand-alone Part D plan. You may also switch to a Medicare Advantage plan that includes Part D coverage. Coverage takes effect Jan. 1.	You cannot enroll in a Medicare Advantage plan during this time period, or switch your Part D plan.
…have recently become or soon will be eligible for Medicare.	If you become eligible for Medicare through age or disability, you have a seven-month window for enrollment in Medicare Advantage and Part D plans: the month you become eligible, the three months prior, and the three months after. If you apply for a Medicare supplement, there is a six-month window from your eligibility date to enroll in a supplement without completing a health questionnaire. If you do not enroll within this time period (unless you have other non-Medicare coverage), you may have special limitations on when you can apply and you may incur cost penalties.
These dates may not apply if you are eligible due to a move, a Special Election Period (SEP) or other exceptions, such as leaving a group plan. Please call us at 1-888-734-3623, 8 a.m. to 5 p.m., Monday through Friday, for more information. TTY users should call 711.

FAQ

Who is eligible?

Anyone with Medicare Parts A and B who lives in the service area can enroll, regardless of age—except those with End-Stage Renal Disease (ESRD).

How do I enroll?

There are several ways to enroll. You can and mail or fax it to Regence at 1-888-335-2988.

You can also get a brochure by mail that contains the application. Complete one application form for each person and return it to us in the envelope provided in the packet. You can also fax it to 1-888-335-2988. Please don't send payment when you apply.

It can take up to a week for us to process your application. So, the sooner you send it in, the sooner we can process it.

For more information, please call us at 1-800-REGENCE (1-888-734-3623). TTY users should call 711. Hours are 8 a.m. to 5 p.m., Monday through Friday.

What are my payment options?

You can pay by check when we bill you, or pay monthly by automatic withdrawal from your bank account. Instructions for automatic withdrawal are in your packet and on our forms page. (Please see the brochure titled "Surepay Authorization.")

You can also choose to have your plan premium taken out of your monthly Social Security check. To learn more, call our Customer Service department at 1-800-541-8981. Our telephone hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. From October 1 through February 14, our telephone hours are 8:00 a.m. to 8:00 p.m., seven days a week. TTY users should call 711.

I have limited income. Can I get help with my Medicare prescription drug costs?

You may be able to get Extra Help paying for your prescription drug premiums and costs. To see if you qualify for Extra Help, call any of the following:

• Medicare: 1-800-MEDICARE (1-800-633-4227). TTY or TDD users should call 1 (877) 486-2048. Offices are open 24 hours a day, seven days a week.
• Social Security: 1 (800) 772-1213. TTY or TDD users should call 1 (800) 325-0778. Offices are open from 7 a.m. to 7 p.m., Monday through Friday.
• Your State Medicaid Office.

Who is Altegra Health™?

Regence has contracted with Altegra Health to do outreach to our Medicare Advantage members who may be eligible to receive Federal or State assistance with paying part of their Medicare premiums.

When will my coverage be effective?

As soon as Medicare verifies your eligibility, we'll notify you of your effective date. If you're newly eligible for Medicare, you may submit your enrollment form up to three months before your effective date.

How do I get care under my new plan?

Simply show your member card to your health care providers so they know who to bill. That's it! In most cases, there's virtually no paperwork. You'll receive a new-member "welcome" packet. You can also give us a call if you have any questions.

Do you have any programs to help me maintain or improve my health?

We offer a number of programs that help promote healthy living. These include:

• A 24-hour nurse phone line
• Members-only discounts on health-related products and services (These programs are not insurance but are offered in addition to your plan to help you stay healthy and live better. The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Regence MedAdvantage grievance process.)
• Reminders for women about breast and cervical cancer screenings
• Informative care programs on asthma, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease and diabetes
• Newsletters
• Online tools
• You also have access to our members-only website, myRegence.com, which provides a number of wellness resources. You will also find a health encyclopedia, information about prescription drugs, a Personal Health Record tool and a history of your claims.

What happens if I travel outside the service area for an extended period of time?

Regence Medicare Advantage PPO plans will cover you for medical emergencies anywhere in the world. If you have to go to a hospital emergency room, you'll pay a copay. For non-urgent or routine care outside the network, you'll pay the copay or coinsurance specified by your plan.

Nationwide, in-network coverage is available in areas where other Blue Cross and/or 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. You may also see an out-of-network provider, but you may pay more.

Part D prescription drug coverage is not available outside the United States and its territories.

What happens if I move out of the service area?

Regence Medicare Advantage and our Medicare Script Part D plans are available only if you live within the plan's service area. If you move, please call us to explore other options.

You may be able to enroll in a Regence Medicare Advantage plan that's offered in another Regence service area, or you could take advantage of Blue Cross and/or Blue Shield Plan state transfer options. You could also return to Medicare Parts A and B.

How often will my rates go up?

Any rate increases are effective in January. After that, your monthly premium is guaranteed not to change until January of the following year. We'll notify you each fall about any rate or benefit changes for the coming year.

Does it cost more to buy coverage through an agent?

No. There's never an extra cost or obligation if you use an appointed agent. Agents who are appointed to represent Regence provide a valuable service and often can help you decide which of our Medicare plans is best for you.

What if I don't want the prescription drug coverage?

Choose the Regence MedAdvantage Basic (PPO) plan. Keep in mind that if you don't have other creditable drug coverage and don't choose a Medicare Part D prescription drug plan when you're eligible, there will be a penalty for every month you could have enrolled but didn't. So, you'll pay more for prescription drug coverage if you enroll later and can't prove you had other, creditable prescription drug coverage.

What's the advantage of choosing the Regence MedAdvantage + Rx Classic (PPO) or the Regence MedAdvantage + Rx Enhanced (PPO) plan?

These plans give you the convenience of having prescription drug coverage and your medical coverage in a single plan. Plus, you don't have to worry about choosing another Medicare Part D prescription drug plan or incurring a penalty if you don't enroll during your enrollment period. If you do choose another Medicare Part D plan, you'll automatically be disenrolled from your Regence Medicare Advantage health plan.

How are eye exams covered?

Medicare covers the diagnosis and treatment of eye conditions. Members with diabetes can get a dilated eye exam every calendar year. In addition, Regence MedAdvantage covers one routine vision eye exam every year.

Once I join, can I disenroll if I want to?

Your membership in a Regence Medicare Advantage plan or Medicare Script Part D plan is optional. If you change your mind and meet the eligibility requirements, you can disenroll during your Annual Election Period or the Medicare Advantage Disenrollment Period (MADP). Just send us a written request. If you move out of the service area, you qualify for a Special Election Period, during which you can enroll in a plan that's offered in your new area.

If you want to disenroll, make sure you have other coverage in place before you do so.

On what basis could my Regence Medicare Advantage coverage be canceled?

Here are some reasons why your Regence Medicare Advantage coverage would be canceled:

• If you don't retain Medicare Parts A and B.
• If you fail to pay the monthly premium, subject to a 60-day grace period.
• If you commit fraud or allow someone else to use your member card to obtain services.
• If you're fraudulent or make misrepresentations on your individual enrollment form that affect your eligibility to enroll in this plan.
• If you're disruptive, abusive, unruly or uncooperative to the extent that your behavior seriously impairs our ability to provide services to you. Involuntary disenrollment is subject to prior approval by the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare and helps protect your rights.
• If you permanently move out of our service area and don't voluntarily disenroll.
• If CMS were to no longer allow Regence to provide Regence Medicare Advantage or Medicare Script Part D coverage to Medicare beneficiaries.
• If Regence chooses to no longer offer Regence Medicare Advantage or Medicare Script Part D plans.

What are the differences between HMO, PPO, PFFS and Medigap plans?

Health Maintenance Organizations (HMO) are managed care plans that require you to use only contracted doctors and hospitals to receive benefits; typically, you need a referral to see a specialist. Preferred Provider Organizations (PPO) also have a provider network. You're covered if you go outside the network, but you pay less when you stay inside it. Many don't require referrals. HMOs and PPOs may have more benefits than Medicare, such as routine vision care. HMOs and PPOs roll Medicare Parts A and B benefits and additional benefits into one plan (Regence Medicare Advantage plans are PPOs.) Private-fee-for-service plans (PFFS) also combine Medicare Parts A and B with new benefits. They have provider networks. However, you can still see out-of-network providers, but you might pay more for services. Also, out-of-network providers may decide not to treat you even if you've seen them before. Medigap plans are secondary to Medicare. They don't have a network of providers, and they usually cost more than HMOs and PPOs. Most Medigap plans don't cover dental or vision exams.

is a Health plan with a Medicare contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, co-payments, and restrictions may apply. Anyone who resides in our service area may apply. Individuals must have both Part A and Part B to enroll. You must continue to pay your Medicare Part B premium. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. Certain eligibility periods and requirements apply.

Medicare Coverage Updates

MEDICARE APPROVES COVERAGE FOR LUNG TRANSPLANT PATIENTS PARTICIPATING IN AN APPROVED CLINICAL TRIAL

The Centers for Medicare & Medicaid Services (CMS) recently approved for payment a procedure for patients who have received lung transplants and are experiencing complications associated with brochiolitis obliterans syndrome (BOS).

Coverage has been added for extracorporeal photopheresis treatment for patients participating in clinical research trials between April 30, 2012 and April 30, 2014. The only patients who qualify for the treatment are those who have received a lung transplant and then developed progressive BOS that is not responsive to immunosuppressive drug treatment and are in an approved clinical research trial.

MEDICARE NOW COVERS SCREENING AND COUNSELING FOR ALCOHOL MISUSE AND SCREENING FOR DEPRESSION

The Centers for Medicare & Medicaid Services (CMS) announced on October 14, 2011, two new preventive benefits for Medicare beneficiaries that cover alcohol misuse screening and behavioral counseling, and screening for depression. These new benefits are added to the existing portfolio of covered preventive services available to Regence MedAdvantage members. There is no copay, coinsurance or deductible for Medicare-covered preventive services.

An annual alcohol misuse screening by a primary care provider, such as a beneficiary's family practice physician, internal medicine physician, or nurse practitioner, in settings such as a physician's office, is covered. The benefit also includes four behavioral counseling sessions per year furnished by the primary care provider if the beneficiary screens positive for alcohol misuse.

An annual screening for depression for Medicare beneficiaries is also now covered in a primary care setting that has staff resources to follow up with appropriate treatment and referrals. The purpose of this screening is to assure accurate diagnosis, effective treatment and follow-up. This benefit is available to Regence MedAdvantage members. There is no copay, coinsurance or deductible for Medicare-covered preventive services.

MEDICARE EXPANDS COVERAGE OF CARDIOVASCULAR DISEASE PREVENTION SERVICES

The Centers for Medicare & Medicaid Services (CMS) announced on November 8, 2011, that Medicare is adding coverage for a number of preventive services to reduce cardiovascular disease. This new coverage will add to the existing portfolio of free preventive services that are now available for people with Medicare.

Under this coverage, Regence will cover one face-to-face visit each year to allow patients and their care providers to determine the best way to help prevent cardiovascular disease. The visit must be furnished by primary care practitioners, such as a beneficiary's family practice physician, internal medicine physician, or nurse practitioner, in settings such as physicians' offices. This benefit is available to Regence MedAdvantage members. There is no copay, coinsurance or deductible for Medicare-covered preventive services.

Additional information on all Medicare-covered preventive services can be found at http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx

MEDICARE NOW COVERS SCREENING AND COUNSELING FOR OBESITY

The Centers for Medicare & Medicaid Services (CMS) announced on November 29, 2011, that Medicare is adding coverage for preventive services to reduce obesity.

Screenings for obesity and counseling for eligible beneficiaries by primary care providers in settings such as physicians' offices are covered under this new benefit. For a beneficiary who screens positive for obesity with a body mass index (BMI) ≥ 30 kg/m2, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. The beneficiary may receive one face-to-face counseling visit every month for an additional six months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds (or 3 kilograms) during the first six months of counseling. This benefit is available to Regence MedAdvantage members. There is no copay, coinsurance or deductible for Medicare-covered preventive services.

MEDICARE ANNOUNCES SCREENING AND COUNSELING FOR SEXUALLY TRANSMITTED INFECTIONS (STIs)

The Centers for Medicare & Medicaid Services (CMS) announced on November 8, 2011, that Medicare will cover screening for Sexually Transmitted Infections (STIs) in certain situations.

The covered screening lab tests must be ordered by a primary care practitioner and performed by an eligible Medicare provider. CMS will also cover up to two individual counseling sessions annually if the Medicare beneficiary is referred by a primary care provider and counseling is provided by a Medicare-eligible primary care provider in primary care settings such as doctors offices. This benefit is available to Regence MedAdvantage members. There is no copay, coinsurance or deductible for Medicare-covered preventive services.

MEDICARE EXPANDS TREATMENT OPTIONS FOR PATIENTS WITH ADVANCED PROSTATE CANCER

Medicare announced on June 30, 2011 that it will now cover the first FDA-approved immunotherapy for prostate cancer treatment. Coverage for PROVENGE®, for asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer is limited to one (1) treatment regimen in a patient's lifetime, consisting of three (3) doses with each dose administered approximately two (2) weeks apart.

For more information contact your doctor.

More information for patients and health professionals about the FDA's approved uses of Provenge® is online at: http://www.fda.gov/BiologicsBloodVaccines/CellularGeneTherapyProducts/ApprovedProducts/ucm210037.htm

Other Resources

Medicare
The official U.S. government site for information about Medicare:
http://www.medicare.gov

Medicaid
The official U.S. government site for information about Medicaid:
http://www.cms.gov/home/medicaid.asp

Health News and Information: Medline
Health news and information from the National Library of Medicine and the National Institutes of Health:
http://medlineplus.gov/

National Institutes of Health
The primary Federal agency for conducting and supporting medical research:
http://www.nih.gov/

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