Medicare Q&A

Answers to Some Commonly Asked Questions About Medicare

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 BCBSAZ Medicare supplement plans help provide additional health care coverage to Original Medicare covered services.

When choosing a Medicare supplement plan, you’ll want 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.

To enroll in a BCBSAZ Medicare supplement plan you must:

  • Be over age 65, and
  • Be eligible for Medicare Part A and enrolled in Part B, and
  • Must live in the state of Arizona, and
  • Continue to pay your Part B premium (and Part A if applicable, if not paid by Medicaid or another third party)

The best time to buy a Medigap policy is during your Medigap open enrollment period, when you have the right to buy any Medigap policy offered in Arizona.  However, even if you aren't in your Medigap open enrollment period there are several situations you may still have a guaranteed right to buy a Medigap policy. 

Guaranteed issue rights are rights you have in certain situations when insurance companies are required by law to offer you certain Medigap policies even if you have health problems and must cover any pre-existing conditions.

If you are not in a guaranteed issue period, you are required to pass underwriting after you submit your application.

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 Part D 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 to 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 to 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:

  • Your health care benefits through Original Medicare and a Medicare Supplement/Medigap plan or another type of plan that isn’t a Medicare Advantage Plan. With these types of health insurance plans, you may choose a Medicare Prescription Drug Plan like Blue MedicareRx.
  • Your health care benefits through the Original Medicare Plan and choose a Medicare Prescription Drug Plan like Blue MedicareRx.
  • Your health care benefits through another type of Medicare Advantage health plan. Generally, you must then receive any prescription drug benefits through that health plan.

If you already have prescription coverage from other insurance, you can keep that coverage. If that coverage offers the same or better benefits as described above, 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 when you become Medicare eligible means you will not have to pay a penalty. You can also gain protection from unforeseen, catastrophic drug expenses.

If your group, employer or union plan covers as much as or more than a Medicare prescription drug plan you can:

  • Keep your current drug plan. If you join a Medicare prescription drug plan such as Blue MedicareRx later, your monthly premium won’t be higher (no 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.

If your employer or union plan covers less than a Medicare prescription drug plan you can:

  • 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.

You may be able to get extra help to pay for your prescription drug premiums and costs, based on your income.   To see if you qualify for extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, seven days a week; or
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or
  • Your State Medicaid Office.

 

Learn what your monthly plan premium will be if you qualify for subsidies for people who need extra help.

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.