Questions and answers about Medicare plans
Medicare does not cover the 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 because they are still covered by an employer’s plan or their spouse’s health plan. However, if you do not join Part B right away and you are not covered under another health care plan, the Part B premium will increase 10 percent each year after you were first eligible to purchase it. 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.
Both of these plans help cover health care expenses not covered by Medicare. Medicare Advantage plans include your Original Medicare benefits and other benefits in one plan. If you join a Medicare Advantage plan (like MedicareBlue PPO (Regional PPO)), you will use one member ID or health care card for your health care and prescription drug needs. You do not need an additional Medicare supplement plan. Medicare supplement plans allow you to enhance your Original Medicare coverage by selecting only those additional benefits that are important to you.
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.
To be eligible for either a Medicare Advantage plan or a Medicare Supplement plan, you must have Medicare Part A and Part B and continue to pay your Part B premiums (and Part A, if applicable) unless otherwise paid for by a third-party. To be eligible for MedicareBlue Rx (PDP), you may have either Part A or Part B — you do not need to have both.
No. You get all of your original Medicare benefits plus additional benefits.
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 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 join a plan, drop a plan, or change plans only during the annual enrollment period of November 15 through December 31 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 your health care benefits and prescription drugs through a Medicare Advantage plan like MedicareBlue PPO (Regional PPO) that offers medical and prescription drug coverage in one plan.
- Your health care benefits through the Original Medicare Plan and choose a Medicare Prescription Drug Plan like MedicareBlue Rx (PDP).
- 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.
- Your health care benefits through a Medicare Supplement/Medigap 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 Medicare Prescription Drug Plan like MedicareBlue Rx.
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 higher premium 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 feel secure that you will be protected from any unforeseen, catastrophic drug expenses.
If your 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 Medicare Blue Rx (PDP) 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 will 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.
You should check with whoever answers questions for your plan for more information about your employer or union drug plan.
You may be able to get extra help to pay for your prescription drug premiums and costs.
To see if you qualify for getting extra help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week;
- 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.
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