Monday, November 5, 2012



Jennifer Moss Lewis, Marketing & Communications Manager 
PacificSource Government Programs 
(541) 330-4993,  

Jenn Connor, Red Sky Public Relations 
(208) 724-2269,  

Five Important Things to Know About Medicare

PacificSource provides information on annual enrollment and Medicare Advantage plans

BOISE, ID – November 5, 2012 – Entering into the world of Medicare can be confusing. Even for those already on a Medicare plan, there are a lot of options to consider. PacificSource wants to help Medicare beneficiaries make informed decisions about their healthcare choices this enrollment period by providing five important things everyone age 64 and older, or eligible for Medicare should know about their options.

#1: Annual Enrollment Period is open now.

Once a year, those on Medicare have the opportunity to make adjustments to their coverage. This year the Annual Enrollment period opened October 15 and will run through December 7. During the Annual Enrollment period, members can join a Medicare Advantage plan, change plans and add or drop Part D prescription drug coverage. Changes made to coverage before December 7 will be active as of January 1, 2013. If coverage changes are not made before December 7, current coverage will remain through 2013.

#2 Enrollment options are different for folks turning 65.

Those ‘aging in’ to Medicare have an enrollment window that opens three months prior to their 65th birthday and closes three months after. Once this window closes, the next opportunity to enroll in a Medicare plan is generally during the next Annual Enrollment period.

#3 Medicare covers a lot, but not everything.  

Original Medicare only pays for 80% of Medicare approved charges – after a member pays their annual deductible – leaving the individual responsible for the rest. “There’s no out of pocket maximum on Medicare,” said Angie Jackson, PacificSource Idaho Individual Representative. “Twenty percent may not seem like a lot, but it can be a significant expense, depending on the service being charged.”

#4 Medicare, Supplement and Advantage plans provide different benefits.

Original Medicare isn’t the only option. Members can enroll in a Medicare Supplement plan or a Medicare Advantage plan to fill the gaps in coverage by Original Medicare.

Medicare Supplement plans are standard plans offered by private companies. Plans are virtually identical from company to company. With these plans, Medicare is billed first and pays up to the Medicare approved amount. Then the Supplement plan is billed and pays its part of the bill. On a Medicare Supplement plan, members can see only providers that accept Medicare. Premiums are based on age and increase as
members get older.

Medicare Advantage plans (Medicare health plans provided by private companies contracted with Medicare) include Part A, B and sometimes Part D prescription drug coverage in one plan. Medicare Advantage plans fill in the gaps in Medicare alone, including prescription drug coverage, and may include additional benefits not covered by Medicare such as routine annual physicals, worldwide coverage for urgent and emergent care, alternative care, and routine eye exams. There are a lot of plan designs and providers members can see vary by plan. Providers work directly with the insurer, who pays both Medicare’s share of the bill as well as any other services covered by the Medicare Advantage plan that are not covered by Original Medicare, reducing the paperwork and confusion for the member. Premiums are not based on age – everyone on the plan pays the same premium.

“There are two benefits to enrolling in a Medicare Advantage plan, said Jackson. “First, members and providers deal with a private company rather than Medicare directly. And, second, Advantage plans take a more active role in managing the money so Medicare dollars can stretch further.”

#5 Assess all expenses.

It is important to not choose a plan based solely on the premium. Take a look at all of the expenses, including deductibles, coinsurance, copayments, and out-of-pocket maximums. These can vary significantly from plan to plan. Also, it is important to know what providers and hospitals are in a plan’s provider network. For those that travel or spend the winter in a warmer climate, it’s also important to know what coverage is available out of the area.

“There are lots of resources out there,” said Jackson. “We encourage folks to contact the plans or local agents in their area to understand their options and make their changes prior to the December 7 deadline.”

For more information on Medicare, Medicare Supplement or Medicare Advantage plans, visit, or call Toll Free at (88) 863-3637.

About PacificSource Health Plans

PacificSource Health Plans is an independent, not-for-profit community health plan serving the Northwest. Founded in 1933, PacificSource is based in Eugene, Oregon, with local offices throughout Oregon and in Idaho and Montana. The PacificSource family of companies employs 600 people, serves more than 275,000 individuals, and has 6,200 employer clients throughout the Northwest. PacificSource Community Health Plans, Inc. is a subsidiary of PacificSource Health Plans and markets Medicare Advantage products under the name PacificSource Medicare.

InTouch for Members

Last updated 7/5/2013