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Providence Health Plan is a health plan with a Medicare contract. - page 26 / 32





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Authorization does not guarantee benefits or payment. Benefits are based on eligibility at the time the service is rendered and are subject to any applicable contract terms.

HOSPICE (CONTINUED FROM PAGE 8) Who pays for my Hospice Care if I’m in a Medicare Advantage Plan like Providence Medicare Advantage Plans?

All Medicare-covered services you get while in hospice care are covered under Original Medicare, even if you are in a Medicare Advantage Plan. However, Providence Medicare Advantage Plans will continue to cover you for any extra services not covered by Original Medicare (like vision benefits, including Part D drugs not related to your terminal hospice related diagnosis). If you choose to stay in your Medicare Advantage Plan while getting hospice care, you must continue to pay your plan’s monthly premium.

AMBULANCE SERVICES (CONTINUED FROM PAGE 9) Copay applies each way for Medicare-covered Ambulance Benefit.

URGENTLY NEEDED CARE (CONTINUED FROM PAGE 10) As a member of Providence Medicare Advantage Plans urgent care visits are covered worldwide.

COLORECTAL SCREENING EXAMS (CONTINUED FROM PAGE 13) You may be charged an office visit copay and/or a separate outpatient services/surgery copay.

IMMUNIZATIONS (CONTINUED FROM PAGE 13) What you pay at the time you get the immunization can vary depending on the circumstances. What you pay depends on three things: The type of vaccine (What you are being vaccinated for): They may be considered medical benefit or Part D benefit. Where you get the immunization medication: You can get vaccinated at your participating pharmacy or your doctor’s office. Who gives you the immunization shot: You get the medication at your participating pharmacy and take it to your doctor’s office where they give you the vaccination shot.

The rules for coverage of immunizations can be complicated. We can tell you about how your immunization is covered and explain your share of the cost. Please call your Providence Medicare Advantage Plans Customer Service team for assistance.

It may be to your benefit to get your Part D immunizations from your participating immunizing pharmacy. If you get your immunizations at your doctor’s office you may pay more than you would if you use a participating pharmacy. Contact plan for details. If you are in the coverage gap you are responsible for the entire cost of the immunization and administration.

END-STAGE RENAL DISEASE (CONTINUED FROM PAGE 14) Out-of-area Renal Dialysis Services do not require authorization.


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