You may be asking “What is Medicare?” as you approach turning 65. The original Medicare health plan started in 1965. The federal government designed it to cover part of the health care costs of people who have retired and those with qualifying disabilities.
You can enroll in Medicare three months before your 65th birthday. The window to enroll stays open until three months after your 65th birthday. During this initial enrollment period, you have guaranteed issue rights. You cannot be turned down for supplemental coverage due to your health history. It is important to speak with a Medicare expert like the ones at BlueCross BlueShield of South Carolina before you turn 65.
Medicare has four parts. Each one provides coverage for different expenses. Part A covers hospital costs. Part B covers medical expenses. For most people, Part A does not have a premium. Part B usually has a monthly premium. Neither Part A nor Part B has maximum out-of-pocket limits. They generally do not offer coverage outside of the U.S. Part A and Part B together are called Original Medicare.
To help cover out-of-pocket costs and the coverage gaps of Original Medicare, you have some enrollment options. You could choose a Medicare Advantage plan, Medicare Supplement, or a Medigap plan. A Medicare Supplement, Medigap or Medicare Advantage plan can protect you from unlimited out-of-pocket costs and help to cover services not covered by Medicare.
These include things like foreign travel emergency coverage, vision, dental and hearing. Some plans cover things like gym memberships and rides to and from doctor appointments.
Medicare can be confusing. The first step in making the best choice for your budget and health is to understand the parts of Medicare and what each one covers.
The Parts of Medicare Coverage
The four parts of Medicare are Part A, Part B, Part C and Part D. As we mentioned, Part A and Part B are Original Medicare. Part C and Part D are coverage options, and they are only available through private insurance carriers like BlueCross.
Part A is hospital insurance. It applies to hospital inpatient care, skilled nursing facility care and hospice care. Part A does not cover long-term or custodial care. Make sure you understand the deductibles and copays associated with the services Part A covers.
Part B is medical insurance. It covers:
- Regular doctor visits.
- Outpatient care.
- Outpatient surgery.
- Ambulance rides.
- Emergency room visits.
- Some durable equipment, such as wheelchairs, walkers, oxygen and other equipment.
Part B also covers mental health and preventive services. These include annual screenings and many vaccines. Make sure you understand the deductibles, coinsurance and copays associated with the services Part B covers.
Part B covers a limited number of prescription drugs, like chemotherapy. If you only have Original Medicare, you pay 100 percent for most drugs you can buy at a pharmacy.
Part C is known as a Medicare Advantage plan. You buy Medicare Advantage plans through private companies such as BlueCross. With a Medicare Advantage plan, you will receive coverage for all Part A & B covered services. Most Medicare Advantage plans also include Part D drug coverage, which is called a Medicare Advantage prescription drug plan.
These plans generally have a network of doctors and offer lower out-of-pocket costs than Original Medicare. Part C plans have different copays and different provider networks. Some Medicare Advantage plans may also cover services such as vision, hearing and dental.
Part D covers a range of prescription drugs that Medicare members will likely need. The list of drugs covered by a Part D plan is called a formulary. Formularies are broken down into tiers. Drugs on lower tiers cost less to the Part D plan member than drugs on higher tiers. Make sure any prescriptions you take are listed in a plan’s formulary and your preferred pharmacy is in the Part D plan’s network.
You Are Not Alone
BlueCross agents are ready to help you every step of the way. They can help you weigh your coverage options, compare plan combinations and help you feel confident you are making the right choices for your health.
BlueCross agents can help you:
- Estimate your monthly drug and medical costs.
- Research doctors and hospitals to make sure your doctor is in network.
- Review current prescriptions and Part D formularies.
- Compare costs for unexpected health care services.
- Review the details and costs of different plan options.
We’re Here To Help
At BlueCross, you will find answers to your Medicare questions. You’ll also find health plans to suit your lifestyle. More importantly, you’ll find someone who can guide you to the right choices for your health and your peace of mind.