The A, B, C, Ds of Medicare

Who is Entitled to Medicare Benefits?

If you or your spouse worked for at least 10 years in Medicare-covered employment and you are a citizen or permanent resident of the United States you are eligible for Medicare when you reach age 65, regardless of your income or health status. If you aren’t yet 65, you might also qualify for coverage if you have a disability or End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, please call Social Security at 1-800-772-1213 or visit or call your local Social Security office . TTY users should call 1-800-325-0778. You can also get information about buying Part A as well as Part B if you don’t qualify for premium-free Part A.

What Are the Different Parts of Medicare?

Medicare Part A – Hospital Coverage

Benefits

Part A is administered by Medicare and provides Medicare benefits and coverage for:

• Inpatient hospital stays
• Care in a skilled nursing facility
• Hospice care
• Some home health care services

Cost

You can get Part A at age 65 without having to pay premiums if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to get Social Security or Railroad benefits but haven't yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if you have:

• Received Social Security or Railroad Retirement Board disability benefits for 24 months.
• End-Stage Renal Disease and meet certain requirements.

If you are 65 and you don't automatically get premium-free Part A, you may be able to buy it if you (or your spouse):

• Are not entitled to Social Security because you didn't work or didn't pay enough Medicare taxes while you worked.
• Are disabled but no longer get premium-free Part A because you returned to work.

Contact Medicare for more information.

Enrollment

You are automatically enrolled in Part A the first day of the month you turn 65 if you get benefits from Social Security or the Railroad Retirement Board (RRB). If you are under 65 and disabled, you will automatically be enrolled after the first day of the 25th month of your disability benefits from Social Security or the RRB.

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Medicare Part B – Medical Coverage

Benefits

Part B provides many of the medically necessary services not covered in Part A. Part B is also administered by Medicare and provides Medicare benefits and coverage for:

• Doctor and clinical lab services
• Outpatient and preventive care 
• Screenings, surgical fees and supplies
• Physical and occupational therapy

Cost

Most people paid $96.40 per month for 2010. This is usually withheld from your Social Security Check. If your income is above $85,000 for an individual or $170,000 for a married couple, your monthly premium will be higher.

Enrollment

You are automatically enrolled in Part B the first day of the month you turn 65 if you get benefits from Social Security or the Railroad Retirement Board (RRB). If you are under 65 and disabled, you will automatically be enrolled after the first day of the 25th month of your disability benefits from Social Security or RRB. If you don’t want to keep Part B, follow the instructions that   come with your Medicare card and send the card back. You should receive this in the mail three months prior to your 65th birthday or your 25th month of disability benefits. If you keep your Medicare card, you keep your Part B benefits.

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Medicare Part C – Medicare Advantage Plans

Benefits

Medicare Advantage plans are health plan options that are run by private health insurance companies like BlueCross BlueShield of Tennessee and are approved by Medicare. A Medicare Advantage plan covers the same services as Original Medicare (Part A and Part B).

• Your costs may be lower than in the Original Medicare Plan.
• You may get extra benefits offered by the plan such as coverage for vision, hearing, dental and wellness programs, as well as special discounts on health-related items.
• Prescription drug coverage may be included as part of the plan.
• You don't need to buy a plan to supplement Medicare Part A and Part B.
• You still have all of the rights and protections offered through the Medicare program.

Cost

Premium and coverage vary by company and you must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party.

Enrollment

You must be enrolled in Medicare Parts A and B to enroll in a Medicare Advantage plan. Your initial election period for Medicare Advantage lasts for 7 months. This includes the month you become eligible for Original Medicare and the three months prior and after the month you become eligible. After this initial election period ends, you are locked-in to the plan you choose until the next Annual Election Period or Annual Disenrollment Period for Medicare Advantage plans.

It is important to remember that you have an opportunity each year to change your Medicare Advantage plan. However, you can only change at certain times of the year. Please see Dates to Remember for more information.

Click here to shop for 2011 BlueCross BlueShield of Tennessee Medicare Advantage plans.

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Medicare Part D – Prescription Drug Coverage

To round out your health care coverage, BlueCross BlueShield of Tennessee offers prescription drug plans. Medicare Part D prescription drug plans help lower your prescription drug costs and help protect against higher costs in the future.

A Medicare Part D Prescription Drug Plan (PDP) can be a stand-alone plan (not joined with other insurance), like our BlueRx plans – or, they may be combined with a Medicare Advantage plan. A Medicare Advantage plan that includes prescription drug coverage is simply referred to as a Medicare Advantage Prescription Drug plan.

Benefits

• Easy to use
• Low premiums
• Flexible payment options
• Choices of cost and benefit levels;
• Protection against high prescription drug costs  
• Works with Original Medicare, Medicare Supplement plans, or may be included in a Medicare Advantage plan.

Enrollment

If you have Medicare Part A and are a member of Part B, you can enroll in a Part D standalone prescription drug plan. Or you may choose to join a Medicare Advantage plan that includes drug coverage. Your initial election period for Medicare Part D lasts for 7 months including the month you become eligible for Original Medicare and the three months prior and after the month you become eligible.

After this initial election period ends, you are locked-in to the plan you choose until the next Annual Election Period .

It is important to remember that you have an opportunity each year to change your Medicare Part D prescription drug plan. However, you can only change at certain times of the year. Please see Dates to Remember for more information.

Cost

Premium and coverage vary by company and you must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party. You may also qualify for extra help with your prescription drug plan premium and copay . Please see Extra Help with Prescription Drugs for more details.

Click here to shop for 2011 BlueCross BlueShield of Tennessee Prescription Drug Plans

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Medicare Supplement – Medigap Policy

Medicare Supplement plans are private health plan options designed to fill in the gaps of what Original Medicare does not pay. These plans are ran by private health insurance companies like BlueCross BlueShield of Tennessee. Medicare Supplement plans are not part of the Medicare program, however, they are regulated by the state in which you reside and are not a benefit offered by the federal government.

Medicare Supplement plans do not offer prescription drug benefits. To get prescription drug coverage you will need to enroll in a standalone Medicare Part D prescription drug plan, like our BlueRx plans. If you enroll in a Medicare Supplement plan, you should not enroll in a Medicare Advantage plan.

Benefits

• Helps pay your cost of Medicare-covered services, such as copays and deductibles.
• Some plans offer additional benefits not covered by Medicare Parts A and B.
• Can be added to Medicare Parts A, B and D.

Cost

Premium and coverage vary by company. You will pay a monthly premium to the insurance company in addition to your Medicare Part B monthly premium.

Enrollment

The best time to enroll is during the 6-month open enrollment period which begins the first day of the month you are both age 65 and enrolled in Medicare Part B. You cannot be turned down for coverage during this time. You can enroll in a Medicare Supplement plan later, but some insurance carriers may require you to answer health questions and your acceptance in a plan is not guaranteed.

Click here to shop for a BlueCross BlueShield of Tennessee Medigap Policy.

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