Frequently Asked Questions:
Medicare Advantage Changes
Background information:
St. 查尔斯健康系统在俄勒冈中部提供医疗保健服务已有100多年的历史. 因为我们希望稳定我们的核心医疗保健服务，并确保我们有能力在未来100年继续提供高质量的医疗服务, 我们正在重新评估所有医疗保险优惠计划的参与情况.
Open enrollment for Medicare is Oct. 15 to Dec. 我们希望为老年人和其他居民提供信息，帮助他们做出明智的决定.
传统医疗保险和医疗保险优势有什么区别?
原始的或传统的医疗保险是由联邦政府运作和资助的医疗保健. 医疗保险优势计划由私人保险公司运营.
Why is St. 查尔斯重新评估其参与医疗保险优惠计划?
我们发现享受医疗保险优惠计划的病人往往比必要的住院时间更长, 是否更难以安置在熟练的护理设施中，并且他们的医生认为有必要提供医疗保健服务时，他们可能会有很高的拒绝率.
By bringing attention to these issues, St. 查尔斯正在寻求减少医疗服务提供者面临的行政挑战，这些挑战可能导致高倦怠率, while also strengthening the core services we provide to patients.
What plans are being affected now?
Beginning in 2024, St. 查尔斯健康系统将不再是通过Humana提供的医疗保险优势计划的网络内供应商, HealthNet and WellCare. As a result, 目前使用这些计划的患者可能需要选择另一种保险计划，以避免保险范围或支付责任的变化.
When will St. 查尔斯在Humana, HealthNet和WellCare的网络状态变化?
Humana changes as of Dec. 31, 2023.
HealthNet and WellCare coverage changes as of Feb. 1, 2024.
What about PacificSource?
St. Charles Health System最近宣布，它已经与PacificSource达成了一项协议，以促进卓越的癌症治疗, reduces administrative burdens and keeps St. 到2024年，俄勒冈中部的查尔斯医院和诊所将加入太平洋医疗保险优势计划. 该协议包括太平洋资源的俄勒冈健康计划和商业保险计划. Learn more about the agreement.
What plans does St. Charles currently accept?
St. Charles accepts traditional Medicare.
而卫生系统目前正在重新评估其持续参与所有医疗保险优势计划, 它将在年初接受以下计划:PacificSource, Providence, Moda and Regence Blue Cross Blue Shield.
Visit our Insurance Information page for more information.
Can patients on Humana, 健康网或健保医疗保险优势计划切换到另一个医疗保险优势计划?
St. 在可预见的未来，查尔斯将继续重新评估其正在参与的所有医疗保险优势计划. This means if you switch to another Medicare Advantage plan, St. Charles不能保证将来作为网络内的保险提供商参与这些保险计划. St. 查尔斯将继续作为传统医疗保险和所有医疗保险补充计划的网络内提供者参与.
如果您希望了解您的保险选择，我们建议您联系:
俄勒冈州高级健康保险福利援助(SHIBA)电话800-722-4134，选项2，
800-MEDICARE (800-633-4227),
Council on Aging of Central Oregon at 541-678-5483,
or an insurance broker of your choosing.
What does out of network vs in network mean?
网络外指的是没有与特定健康保险计划签订合同的医疗保健提供者. If patients use an out-of-network provider, 医疗保健服务可能会花费更多，因为提供者没有预先与健康计划协商的费率.
一个医疗系统不再接受保险公司的医疗保险优势计划，这是不寻常的吗?
No. In fact, in recent years, 越来越多的医院和医疗系统不再接受联邦医疗保险优惠计划(“Hospitals are dropping Medicare Advantage left and right”).
积极接受癌症护理治疗的患者呢, outpatient rehab, wound care, or dialysis care?
People undergoing an active treatment plan, for these covered and approved services, will continue to receive treatment from St. Charles. 这种持续护理包括接受术后护理的患者, those with urgent/emergency medical conditions, those mid-treatment for serious medical conditions, those on high-risk medications that require monitoring, 那些需要定期注射和长期控制药物的人. 确定保险范围或付款义务的任何变化, we recommend contacting Humana, 直接拨打您的保险卡上的电话号码，以确定具体的保险范围和支付责任.
参加Humana、HealthNet和WellCare医疗保险优势计划的患者能否继续接受St. Charles’ hospitals and physicians for other services?
除上述服务及急症室、急症室及化验室服务外，澳门皇冠app官网手机版app下载将不会为受影响的医疗保险优惠计划(12月6日)的病人安排或允许预约门诊和选择性服务. 31 for Humana and Feb. 1, 2024 for WellCare and HealthNet). 我们建议通过拨打您的保险卡上的电话号码直接与您的健康保险提供商联系，以确定具体的保险范围和支付责任.
How do patients continue to see St. Charles physicians or St. Charles hospitals as an “in-network” provider?
To be treated by a St. Charles physician as an “in-network” provider, 患者需要将他们的保险计划改为像传统医疗保险那样的“网络内”计划.
如果您希望了解您的保险选择，我们建议您联系:
俄勒冈州高级健康保险福利援助(SHIBA)电话800-722-4134，选项2，
800-MEDICARE (800-633-4227),
Council on Aging of Central Oregon at 541-678-5483,
or an insurance broker of your choosing.
Which insurance plan does St. Charles recommend?
这是每个病人需要根据自己的个人需求做出的决定. 你可以在这里找到一份St. Charles on our Insurance options webpage.
如果您希望了解您的保险选择，我们建议您联系:
俄勒冈州高级健康保险福利援助(SHIBA)电话800-722-4134，选项2，
800-MEDICARE (800-633-4227),
Council on Aging of Central Oregon at 541-678-5783,
or an insurance broker of your choosing.
What is the deadline to make a change?
更改应在年度福利开放登记期间进行，即 Oct. 15 – Dec. 7.
How can I learn more?
个人应该联系他们的保险公司了解更多关于他们的保险范围.
Our St. Charles team is available to answer questions on our call line at 541-612-8378.
Individuals wishing to explore insurance options can contact:
俄勒冈州高级健康保险福利援助(SHIBA)电话800-722-4134，选项2，
800-MEDICARE (800-633-4227),
Council on Aging of Central Oregon at 541-678-5783,
or an insurance broker of your choosing.
