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Changing Your Medicare Plan

How to Change to Another Providence Medicare Plan

Getting started with Providence Health Plan is as easy as 1-2-3.

  1. Print the Plan Change Form. (PDF 106kb)
  2. Fill it out.
  3. Mail it to Providence Health Plan at the address listed on the form or fax it to 1-800-396-4778.

You will receive a notice in the mail acknowledging receipt of the completed plan change or a request for additional information if the form is not complete.

Members May Enroll in a Plan Only During Specific Times of the Year.

The Open Election Period (OEP) is January 1 - March 31.

Remember, the most important thing with the OEP is that a member cannot add or drop Medicare Part D prescription drug coverage. Most changes are effective the first of the following month.

The following table can help explain the type of changes that can be made during the OEP.

If current coverage is Can use
OEP to get
Cannot use
OEP to get
Medicare Advantage (MA) with prescription drug coverage (MA-PD) MA-PD or Original Medicare + PDP MA-only or Original Medicare only
Medicare Advantage with no prescription drug coverage (MA-only) MA-only or Original Medicare only MA-PD or Original Medicare + PDP
Original Medicare and a prescription drug plan (PDP) MA-PD MA-only or A different PDP to use with Original Medicare
Original Medicare only MA-only MA-PD or Original Medicare + PDP

Providence Health Plan's contract with CMS is renewed annually and that the availability of coverage beyond the end of the current contract year is not guaranteed.

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"Pending CMS Approval"

Revised 11/08
H9047 UF ADV 16_09 (11/08)