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 per benefit period.

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.

Deductibles, coinsurance and premium amounts for Parts A & B change annually.

Medicare Advantage is the name for a few different types of plans that contract with the federal government. Medicare Advantage plans include a Health Maintenance Organization (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.

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).

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.

• 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.

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.

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, with the exception of emergency or urgent care. 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.

You can check online in the Find a Provider section to see if a provider is on our network, or request a printed version of our provider listings.

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

With all of our Regence MedAdvantage plans, a member can go to any dentist* and is covered up to $500 annually with 20% member coinsurance for routine preventive dental services such as cleanings, x-rays and exams. See the Summary of Benefits (PDF) for limitations.

With all of our Regence MedAdvantage (PPO) plans, members are eligible for routine vision exams once every calendar year for in-network services. For Regence MedAdvantage (PPO) + Rx Enhanced, there is a $30 copay per visit for utilizing in-network services and vision hardware is covered up to $200 every year. For Regence MedAdvantage (PPO) and Regence MedAdvantage (PPO) + Rx Classic, there is a $40 copay per visit for utilizing in-network services and vision hardware is covered up to $100 every year.

For Medicare-covered hearing exams (diagnostic hearing exams), there is a $10 copay per primary care provider visit with Regence MedAdvantage (PPO) + Rx Enhanced for in-network services and $30 copay for either primary or specialty-care provider visits for out-of-network services. A $15 copay applies to Regence MedAdvantage (PPO) and Regence MedAdvantage (PPO) + Rx Classic for in-network primary-care provider services and $40 copay for either primary or specialty-care provider visits for out-of-network services.  

Are prescription drugs covered?

Yes, if you choose Regence MedAdvantage (PPO) + Rx Enhanced or Regence MedAdvantage + Rx Classic. You pay a share of your prescription medication costs (copays or coinsurance), and your plan pays a share.

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 premium penalty for every month you could have enrolled but didn't.

Access to discount programs such as vision care services, hearing care services, discounts at fitness clubs and discounts on prescription medications.

• These programs are not insurance, but are offered in addition to your medical or prescription drug plan to help you take charge of your health. (The products and services described above are neither offered nor guaranteed under our contract with the Medicare program described above. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Asuris grievance process)

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.

You may disenroll from your Regence MedAdvantage Plan and return to Original Medicare from January 1 through February 14 during the Medicare Advantage Annual Disenrollment Period (MAADP). You may also select a stand-alone Part D plan during this time period if you choose to disenroll.

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 unless you choose to disenroll from January 1 through February 14.

Please read the Regence MedAdvantage Information Brochure or visit the CMS web site at www.medicare.gov for more information on eligibility.

Individuals on limited income, applying for prescription drug plans (such as Regence MedAdvantage + Rx Classic), may qualify for reduced premiums, copayments and/or coinsurance. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;

The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778;

Or your State Medicaid office.

Please also refer to the Low Income Subsidy flyer for more information on help available to people with limited income.
I Have Limited Income What Should I Do? (PDF)