Answers to your most pressing questions about Medicare and Plans from Blue Cross.
Original Medicare is the traditional, fee-for-service healthcare program provided and managed by the U.S. government. In Original Medicare, you are able to go to a doctor or hospital whenever you feel that you need care. You pay for each service that you receive, and there are limits on how much a hospital or doctor can charge you. Part A (hospital insurance) and Part B (medical insurance) are included in Original Medicare.
Medicare does not cover Part A and Part B deductibles and coinsurance. It also does not cover items such as routine hearing exams, eye exams and most outpatient prescription drugs.
Some people don’t need Medicare Part B (medical) because they are still covered by an employer’s or spouse's health plan. However, if you do not join Part B right away and you are not covered under another health care plan, you will have a late enrollment penalty consisting of a 10 percent Part B premium increase per year for each year after you were first eligible. Call 1-800-MEDICARE (1-800-633-4227) for more information, 24 hours a day, seven days a week. TTY users call 1-877-486-2048.
All of these plans help cover health care expenses not covered by Medicare.
- Medicare Advantage plans include Part A and Part B Original Medicare benefits as well as other benefits in one plan. Medicare Advantage plans often also include prescription drug coverage. Types of Medicare Advantage plans include Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).
- Medicare Supplement plans helps to cover the unpaid costs after Medicare Part A and Part B have paid their portion of your healthcare costs. There are several different plans available on the market offered by private companies. Not all companies may offer the same plans and each plan provides different levels of coverage.
- Medicare Cost plans also help pay the deductibles and coinsurance you have with Original Medicare. Companies offering Cost plans may have various options that provide different levels of coverage.
Medicare Supplement or Cost plans allow you to enhance your Original Medicare coverage by selecting only those additional benefits that are important to you. With either of these plans you would need to add a stand-alone prescription drug plan if you wanted that coverage.
To choose, you’ll need to compare the level of coverage for each and see which best fits your needs. Help is available — contact us or call your insurance agent.
Medicare works with private insurance companies to offer prescription drug plans. These Medicare-approved drug plans are also known as stand-alone Part D plans. Medicare Prescription Drug Plans provide insurance coverage for generic and brand-name prescription drugs.
If you join a plan, you will likely pay a monthly premium, plus a share of the cost of your prescriptions. There are different drug plans available that vary by types of drugs covered, how much you have to pay and the pharmacies you can use. All drug plans must provide at least a standard level of coverage.
It is important to join a Medicare Prescription Drug Plan when you are first eligible. Medicare prescription drug coverage not only helps pay for current prescription drug costs, but also helps provide valuable protection from high out-of-pocket costs in the future. Plus, for most people, joining when you are first eligible means you will pay a lower monthly premium than if you decide to join later.
If you become eligible for Medicare:
- Depending on your eligibility date, generally you will have a seven-month Initial Enrollment Period that includes the three months prior to the month you become eligible, the month you become eligible, and the three months after you become eligible.
- After your Initial Enrollment Period ends, you can typically join a plan, drop a plan, or change plans only during the Annual Enrollment Period of October 15 through December 7 each year. Your options are limited at other times of the year.
Enrolling in a Medicare Part D plan is voluntary. To join, you must decide how you want to get your prescriptions. You can get:
- All of your health care benefits and prescription drugs through a Medicare Advantage plan that includes prescription drug coverage.
- Your health care benefits through Original Medicare and choose a Medicare Prescription Drug Plan like Basic Blue Rx.
- Your health care benefits through a private fee-for-service (PFFS) Medicare Advantage health plan or Cost plan and choose a Medicare Prescription Drug Plan like Basic Blue Rx.
- Your health care benefits through a Medicare Supplement or Medigap plan, a Cost plan or a Medicare Managed Care Plan that isn’t a Medicare Advantage Plan. With these types of health insurance plans, you may choose a stand-alone Medicare Prescription Drug Plan like Basic Blue Rx.
If you already have prescription coverage from other insurance, you can keep that coverage. If that coverage offers the same or better benefits than Medicare's drug coverage, you will not have to pay a penalty if you decide to join a Part D plan later. Check with your other insurance to see how your coverage compares.
Even if you don’t use prescription drugs now, you should still consider joining a Medicare Prescription Drug Plan. As we age, most people need prescription drugs to stay healthy. For most people, joining as soon as possible means you pay your lowest monthly premium. You can also gain protection from unforeseen catastrophic drug expenses.
If your employer or union plan covers as much as or more than a Medicare Prescription Drug Plan, you can choose to:
- Keep your current drug plan. If you join a Medicare Prescription Drug Plan such as Basic Blue Rx later, your monthly premium won’t be higher (no penalty).
- Drop your current drug plan and join a Medicare Prescription Drug Plan. If you choose this option, be aware that you may not be able to get your employer or union drug plan back if you change your mind. Check with your employer or union to see if you can rejoin at a later date.
If your employer or union plan covers less than a Medicare Prescription Drug Plan, you can choose to:
- Keep your current drug plan and join a Medicare Prescription Drug Plan to give you more complete prescription drug coverage.
- Just keep your current drug plan. But, if you join a Medicare Prescription Drug Plan later, you may have to pay more for the monthly premium (a late enrollment penalty).
- Drop your current drug plan and join a Medicare Prescription Drug Plan, but you may not be able to get your employer or union drug plan back if you change your mind.
For more information, check with the person that answers questions about your employer or union drug plan.
Late enrollment penalties are incurred when there is a continuous period of at least 63 days or more after the end of a member’s Initial Election Period (IEP) in which they were eligible to enroll in a Medicare Part D plan, but did not enroll and were not covered under a creditable prescription drug coverage plan.
The late enrollment penalty is an added sum to your monthly Medicare Part D premium. The exact amount of the fee is dependent on any period of lapse in the member’s coverage. You will be responsible to pay the penalty fee for the duration of your Medicare prescription drug coverage.