Go to our secure member site »

Learn about Medicare

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 any age for those who qualify because of certain disabilities or medical conditions.

Medicare comes in four parts: Part A, Part B, Part C and Part D. Original Medicare, provided by the federal government, includes Part A and Part B.

Part A: Hospital coverage

When you're first eligible for Medicare, you have a 7-month initial enrollment period to sign up for Part A and/or Part B, but some people are enrolled in Part A and Part B automatically.

Most people get premium-free Part A. You usually don't pay a premium if you or your spouse paid Medicare taxes while working. You can get premium-free Part A at 65 if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You're eligible to get Social Security or Railroad benefits but haven't filed for them yet.
  • You or your spouse had Medicare-covered government employment.

If you're younger than 65, you can get premium-free Part A if:

  • You got Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You have End-Stage Renal Disease (ESRD) and meet certain requirements.

If you get Medicare automatically, you'll get your red, white and blue Medicare card in the mail three months before your 65th birthday or your 25th month of disability.

You may need to sign up for Part A & Part B if:

  • You aren't getting Social Security or Railroad Retirement Board benefits (for example, because you're still working).
  • You qualify for Medicare because you have End-Stage Renal Disease (ESRD).
  • You live in Puerto Rico and want to sign up for Part B (you automatically get Part A). You must already have Part A to apply for Part B.

Part A covers inpatient expenses. These costs usually 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 are responsible for paying some costs before your benefits apply, such as your deductible, and certain costs after the deductible is met.

The federal government administers Part A. To learn more about Medicare Part A, visit http://www.medicare.gov.

Part B: Medical coverage

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

Part B provides coverage for medically necessary services and preventive services. This coverage typically includes:

  • Doctor and clinical lab services
  • Outpatient and preventive care
  • Screenings, surgical fees and supplies
  • Physical and occupational therapy
  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

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

  • Your monthly premium, which is usually deducted from your Social Security payment
  • Specific out-of-pocket expenses, such as your deductible and any cost share (copays and coinsurance) amounts

The federal government administers Part B. To learn 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 Medicare Parts A and B, and may offer additional benefits.

Private insurance companies such as Regence administer Medicare Advantage plans. When you choose a Medicare Advantage plan, you get the same coverage as Medicare Parts A and B, plus benefits that Original Medicare does not cover. These additional benefits vary among individual carriers, but may include features such as dental care, gym memberships and vision care. You can also select a plan that includes RX.

Medicare Advantage plans give you guaranteed access to a wide range of physicians and other health care professionals.

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

Medicare Part D: Prescription drug coverage

Medicare Part D is administered by private insurance companies such as Regence that cover prescription medications.

If you enroll in Original Medicare, you can purchase Part D as a stand-alone Prescription Drug Plan (PDP) to help cover your prescription medication. Or, you can choose to enroll in a Medicare Advantage plan that includes prescription drug coverage.

If you purchase a PDP, you may be responsible for paying a monthly premium. You may also need to pay either a copay or coinsurance amount for your prescriptions.

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

Medigap: Filling in the gaps

A Medigap (Medicare Supplement) plan is administered through private insurance companies, such as Regence. It provides coverage for some health care costs that Original Medicare alone doesn't cover, such as copays, deductibles or coinsurance.

You must be enrolled in Medicare Part A and Part B before you can enroll in a Medigap plan.

Medigap plans do not include prescription drug coverage. However, you can purchase stand-alone Medicare Part D coverage.

Medigap plans are not tied to networks; if you travel and want to see providers in different cities, Medigap may be a good choice for you.

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. We understand you want to choose a Medicare carrier that has the knowledge, experience and tools to help you stay healthy. We offer excellent customer service and a wide selection of plan options so you can find the plan that best fits your needs and budget.

Why choose a Medicare Advantage plan offered by Regence? As a member, you'll appreciate these features.

  • Low maximum-out-of-pocket costs and expenses
  • Extensive provider network to access care when and where you need it, without referrals (PPO only), and a large pharmacy network
  • Free SilverSneakers® gym membership—find a location near you
  • 24/7 nurse line access and other care support programs
  • Discounts on health-related products and services
  • $500 annual dental benefit (PPO only)
  • While traveling in the United States, in-network benefits when you visit PPO providers participating in the Blue Medicare Advantage PPO Network Sharing Program (PPO only)
  • Worldwide urgent and emergency coverage when you travel

Key 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 because of a move, a special election period (SEP) or other exceptions, such as leaving a group plan. Call us at 1 (888) 734-3623, 8:00 a.m. to 5:00 p.m., Monday through Friday, for more information. TTY users, call 711.

Frequently asked questions

Who is eligible?
If you have Medicare Parts A and B and live in our service area, you can enroll. For Medicare Advantage plans some exceptions may apply, including conditions such as End-Stage Renal Disease (ESRD).
How do I enroll?
You have several options:
  • Enroll online for Medicare Advantage, , or Medigap
  • Enroll by U.S. Mail or fax. You can download an application at Forms & documents. Return a separate application for each person you wish to enroll. Mail to the address listed on the form or fax to 1 (888) 335-2988.
  • Enroll by phone at 1 (888) REGENCE (734-3623) (TTY: 711). Hours: 8:00 a.m. to 5:00 p.m., Monday through Friday. October 1 through February 14, phone hours are 8:00 a.m. to 8:00 p.m., seven days a week.
To receive more information on plan options contact us at 1 (888) REGENCE (734-3623).
What are my payment options?
You have the choice of paying for your plan when we bill you, or you can sign up to automatically pay from your bank account. To set up automatic payment, complete the bank authorization section on the enrollment form. For Medicare Advantage and Part D plans you can also choose to have your plan premium taken out of your monthly Social Security check. To learn more, call Regence: 1 (888) REGENCE (734-3623).
I have limited income. Can I get help with my Medicare prescription drug costs?
You may be able to use a program called Extra Help. To see if you qualify for Extra Help for your prescription drug costs, call any of the following:
  • Medicare: 1 (800) MEDICARE (633-4227). TTY: 1 (877) 486-2048. Offices are open 24 hours a day, seven days a week.
  • Social Security: 1 (800) 772-1213. TTY: 1 (800) 325-0778. Offices are open from 7:00 a.m. to 7:00 p.m., Monday through Friday.
  • Your state Medicaid Office.
Who is Altegra Health?
Regence has contracted with Altegra Health™ to contact and assist our Medicare Advantage members, who may be eligible to receive federal or state assistance with Medicare premiums.
When will my coverage take effect?
As soon as Medicare verifies your eligibility, we will notify you of your effective date. If you are newly eligible for Medicare, you may submit your application up to three months before your effective date.

For Medigap, subject to meeting eligibility requirements, your coverage will begin on the first day of the month following our acceptance of your application.
What are the differences between HMO, PPO and Medigap plans?
Health Maintenance Organizations (HMO) are managed care plans that require you to use only contracted doctors and hospitals (in a specific provider network) 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 visit providers outside the network, but you will pay more.

Medigap plans are secondary to Medicare. They don't have a provider network, and they usually cost more than HMOs and PPOs. Most Medigap plans don't offer prescription drug, dental or vision coverage.
How do I get care under my new plan?
Show your member card to your health care providers at each visit so they know whom to bill. In most cases, there is virtually no paperwork. You'll receive a new member welcome packet with more information and you can call us 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
  • Preventive service and screening reminders for Medicare Advantage members
  • Informative care programs on asthma, COPD, congestive heart failure, coronary artery disease and diabetes
  • Access to our members-only website with additional resources
What happens if I travel outside the service area for an extended period?
Regence Medicare Advantage 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 or coinsurance amount. For nonurgent or routine care you may have to pay more if you visit an out-of-network provider.
  • MedAdvantage (PPO) plan: Nationwide, in-network coverage is available if you use contracted providers in areas where the Blue Medicare Advantage PPO network sharing travel program is offered, currently in 34 states and one territory.
  • BlueAdvantage (HMO) plan: You are covered for urgent and emergency care worldwide.
  • Regence Medigap plans: If traveling within the United States, you have the choice of any Medicare approved provider. Medigap Plans C and F provide emergency coverage when traveling outside of the United States.
  • Medicare Part D prescription drug plans: We have more than 63,000 participating pharmacies nationwide, including most national chains. You may have to pay more if you go to an out-of-network pharmacy. Pharmacy coverage is not available outside the United States and its territories with stand-alone Prescription Drug Plans (PDP) and our Medicare Advantage plans.
What happens if I move out of the service area?
Regence plans are only available to those who live in the plan service area. If you move, call us to explore other options. For Medigap plans, you may be able to take advantage of a Blue Cross and/or Blue Shield plan state-transfer option. You could also return to Medicare Parts A and B.
How often will my rates go up?
For Medicare Advantage plans, any rate increases are effective in January. After that, your monthly premium is guaranteed not to change until January of the following year. We will notify you every fall about any rate or benefit changes for the coming year.

Medigap rate changes happen annually, at your policy’s renewal. We will notify you of rate changes prior to your renewal date.
Does it cost more to buy coverage through an agent?
No. There is 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.

Medigap plans do not offer prescription drug coverage.
What's the advantage of choosing the
These plans give you the convenience of having prescription drug coverage and your medical coverage in a single plan. In addition, 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 a stand-alone Medicare Part D plan, you'll automatically be disenrolled from your Medicare Advantage health plan.
How are eye exams covered?
Medicare covers diagnosis and treatment for eye conditions. Members with diabetes can get a dilated eye exam every calendar year. In addition, Medicare Advantage covers one routine vision eye exam every year.

Medigap plans do not cover routine eye exams but may cover some preventive and diagnostic eye exams.
After I join, may I disenroll if I want to?
Regence Medicare Advantage or Medicare Part D plan membership 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 in your new location.

Medigap plans can be canceled by the member at any time, in writing or by calling Customer Service.
On what basis could my Regence Medicare coverage be canceled?
Medigap, Medicare Advantage or Medicare Part D coverage would be canceled if:
  • You don't retain Medicare Parts A and B
  • You fail to pay the monthly premium, subject to a 60-day grace period
  • You commit fraud or allow someone else to use your member card to obtain services
  • You intentionally misrepresent information on your application form that affects your eligibility to enroll in this plan
Medicare Advantage or Part D coverage would also be canceled if:
  • You are 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.
  • You permanently move out of our service area and don't voluntarily disenroll.
  • CMS were to stop allowing Regence to provide Medicare Advantage or Part D coverage.
  • Regence chooses to no longer offer Medicare Advantage or Medicare Part D plans.

Medicare coverage updates

Medicare expands coverage for Cardiac Rehabilitation Program for Chronic Heart Failure
The Centers for Medicare & Medicaid Services (CMS) has expanded coverage of cardiac rehabilitation to beneficiaries diagnosed with chronic heart failure. Specifically, coverage is permitted for beneficiaries who have experienced one or more of the following:

  • Acute myocardial infarction within the preceding 12 months
  • Coronary artery bypass surgery
  • Current stable angina pectoris
  • Heart valve repair or replacement
  • Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting or
  • Heart or heart-lung transplant

This change adds chronic heart failure to the list of cardiac conditions that would enable a beneficiary to obtain cardiac rehabilitation services. This list will now include:

  • A stable, chronic heart failure defined as patients with left ventricular ejection fraction of 35% or less and New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least 6 weeks (effective February 18, 2014).

The change is effective for dates of services on or after February 18, 2014.
 

Medicare makes determination on the use of beta amyloid positron emission tomography (PET) for dementia and neurodegenerative disease
The Centers for Medicare and Medicaid services (CMS) has determined there is not enough evidence to warrant the use of positron emission tomography (PET) amyloid-beta (Aß) imaging for Medicare beneficiaries with dementia or neurodegenerative disease so it is not covered under those circumstances. However, there is sufficient evidence to allow PET Aß imaging (one PET Aß scan per patient) in two scenarios: (1) to exclude Alzheimer’s disease (AD) in narrowly defined and clinically difficult differential diagnoses, such as Alzheimer’s disease versus frontotemporal dementia (FTD); and (2) to enrich clinical trials seeking better treatments or prevention strategies for Alzheimer’s disease by allowing for selection of patients on the basis of biological as well as clinical and epidemiological factors. This change is effective September 27, 2013.

Medicare covers single-chamber and dual-chamber permanent cardiac pacemakers
The Centers for Medicare and Medicaid services (CMS) concluded that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block. Symptoms of bradycardia are symptoms that can be directly attributable to a heart rate less than 60 beats per minute (for example: syncope, seizures, congestive heart failure, dizziness, or confusion). This change is effective August 13, 2013.


Medicare now covers screening and counseling for alcohol misuse and screening for depression
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 expands coverage of cardiovascular disease prevention services
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.

Find additional information on all Medicare-covered preventive services.


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
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.

Find more information for patients and health professionals about the FDA's approved uses of Provenge®

Regence Advantages

Please enter your zip code to see value-added programs tailored for your region.

Note: To print a PDF document, you need Adobe® Acrobat® Reader. Go to Adobe.com

Last updated 07/14/2014
Y0062_2014_V6_MEDICARE Approved