Knowing which health insurance plan will work best for you isn’t always easy. So, let’s take a closer look at some Blue Cross Blue Shield Medicare coverage plans and how they can help you get the health care you need.
What is Medicare?
There’s a lot of talk about Medicare coverage and other issues about health plans. But these conversations often skip past explaining what Medicare is.
Medicare is a federal health insurance program. Medicare health plans offered are for:
- U.S. citizens age 65 and over, or
- Citizens under 65 with certain disabilities or medical conditions
Medicare has different plans referred to as Parts A, B, C, D and private carriers also issue supplemental plans. These plans cover different health care services and needs.
|Medicare Plans||Part A||Part B||Medicare Advantage (Part C)||Part D||Medicare supplement plans|
|Features||Offers inpatient care and home health care services||Offers doctor services, outpatient care, and medical supplies||Coverage may include wellness programs, hearing aids, and vision services||Offers prescription drug coverage||Help with out-of-pocket costs (such as deductibles, copays and coinsurance) not covered by Part A and Part B|
Medicare Part A and Part B Plans
Medicare Part A and Part B are also known as Original Medicare.
Part A covers:
- Inpatient care offered in hospitals or skilled nursing facilities
- me health care services
- Hospice care for the terminally ill
Part B covers:
- Outpatient care
- Medical supplies
- Durable medical equipment
- Preventive services
Now, let’s take a deeper look at Blue Cross and Blue Shield Medicare’s Advantage plans and Supplement plans
Medicare Advantage Blue Cross Blue Shield Plans (Part C)
Medicare Advantage plans offer Medicare coverage through private health insurance companies approved by the Center for Medicare and Medicaid Services (CMS).
These plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs), regional PPOs and private fee-for-service plans. An organization in these categories usually has a Medicare contract and is a licensee of the Blue Cross Blue Shield Association.
Medicare Advantage plans provide all Part A and B services and some additional services, such as:
- Wellness programs
- Hearing aids
- Vision services
Also, Medicare Advantage plans (such as PPO plans and HMO plans) usually provide prescription drug coverage.
Some of these plans have a maximum that you would have to pay for out-of-pocket costs each calendar year, a feature not offered through original Medicare.
Medicare Advantage plans have location-based service areas and most have networks of doctors and hospitals. So, be sure to ask your doctors if they are in your health insurance plan’s Medicare Advantage network.
How Can I Enroll in a Blue Cross Blue Shield Medicare Advantage Plan?
You must first enroll in Medicare Part A and Part B before joining a Medicare Advantage plan.
Medicare currently offers people an Open Enrollment Period about once a year. This gives you the chance to review and, if you want, make changes to your Medicare coverage. Some of the changes you can make include:
- Joining a Medicare Advantage plan
- Leaving your Medicare Advantage plan and returning to Original Medicare (Part A and Part B)
- Switching from one Medicare Advantage plan to another
- Adding or changing your prescription drug coverage (Part D) plan if you are in Original Medicare
Medicare Advantage plans can be useful. But what if you find out you have gaps in your Medicare health coverage?
That’s where Medigap comes in.
Blue Cross Blue Shield Medicare Supplement Plans
If you have Medicare Part A and Part B coverage, Medicare Supplement (also called Medigap) plans can help fill the coverage gaps in Medicare Part A and Part B. Some Medigap plans even cover foreign travel emergency services.
Medigap plans are sold by private insurance companies. They can help you with out-of-pocket costs (such as deductibles, copays and coinsurance) not covered by Parts A and B.
How Can I Enroll in Medigap?
You must first enroll in Medicare Part A and Part B before joining a Medigap plan.
Even though Medicare has an annual Open Enrollment Period for Medicare Advantage plans, this doesn’t apply for folks wanting Medigap coverage.
The Open Enrollment Period for a Medigap policy is the six-month period that starts the first day of the month that you turn 65 or older and enrolled in Medicare Part B.
After that, your ability to buy one of the Medigap plans depends on which state you live in. This is balanced by the fact that once you’re enrolled in a Medigap plan, it renews annually as long as you pay your premium and the plan is available.
Medicare Prescription Drug Coverage (Part D)
Medicare prescription drug plans (PDP plans) are offered by private health insurance companies and cover your prescription drug costs for covered medications.
You can select a Medicare PDP plan in addition to:
- Original Medicare (Part A and Part B)
- Original Medicare (Part A and Part B) with a Medigap Plan
Part D coverage is included in most Medicare Advantage (Part C) plans.
Blue Cross Blue Shield Medicare Coverage – Frequently Asked Questions (FAQs)
Q: Can I have the Blue Cross Blue Shield Medicare Advantage plan and a Medicare supplement plan at the same time?
A: No. You must pick between the Medicare Advantage plan (Part C) or a Blue Cross Blue Shield Medicare Supplement plan. It is against federal law for someone to be enrolled in both plans at the same time.
Q: How is Medicare different from Medicaid?
A: Medicaid is a state-based health insurance program that covers a set of benefits and services. The program helps low-income individuals and families, people with disabilities and older folks.
Medicare is a federal health insurance program that covers certain benefits and services. This program is primarily for people 65 and older as well as for people under age 65 who have disabilities and/or certain medical conditions.
Medicaid eligibility differs from Medicare eligibility. Certain rules apply for individuals eligible for both Medicare and Medicaid.
The Bottom Line
Getting original Medicare is a good start for basic health care coverage. But you also have additional options with Blue Cross Blue Shield Medicare to help cover more of your health care needs.
Medicare Advantage plans focus on covering additional health care services, including prescription drug coverage. Medigap (or Medicare Supplement) plans focus on helping to keep your out-of-pocket costs for health care affordable.
Choosing the right Medicare plan for you is straightforward. Get your customized Medicare plan quote and learn more about Medicare Advantage and Medicare Supplemental plans.