Your Medicare
Options
Guide Book
bcbsri.com/Medicare
Medicare Part A
Hospital Insurance (see page 4) Original Medicare
Medicare Part B
Medical Insurance (see page 4) Original Medicare
Medicare Part C
Medicare Advantage (see page 5)
Medicare Part D
Medicare Prescription Drug Plan (see page 6)
In addition,Medicare Supplement Plans
—
also known as Medigap Plans—provide coverage that fills in the gaps of Original Medicare. See page 7 for more information.Turning 65? Time to get informed. The A-B-Cs (and D) of Medicare.
Maybe you’re not thinking about retirement yet.
These days people are working and enjoying life
longer than they used to. But one thing hasn’t
changed: You’re still eligible for Medicare when
you turn 65. So why wait to learn more about the
coverage you need to live life to the fullest?
Blue Cross & Blue Shield of Rhode Island
(BCBSRI) is here to help you feel confident in
your decisions—starting with this guide. If you
choose to purchase private Medicare coverage,
we hope you’ll consider BCBSRI. We’re the
market leader for Medicare products (Medicare
Advantage and Medigap) in Rhode Island.*
And we’ve served this community for over
75 years.
Common Health
Insurance Terms
Premium
The amount you pay, typically per month, for health insurance coverage. Deductible
The amount you must pay before the plan starts to pay for your medical expenses. For some plans, you do not have to pay a deductible. Copayments/Coinsurance A copayment is a set amount you pay for medical expenses, regardless of the total cost. Coinsurance is a percentage you pay of the total cost. Formulary
The list of prescription drugs that the plan covers. Each plan’s formulary is different, so check to see if your medications are covered. Some plans offer enhanced coverage.
Medicare coverage is divided into several categories—or parts—to allow you to
customize your coverage to your situation.
The categories are labeled A, B, C, and D, as follows:
Medicare Part A covers inpatient care in hospitals, skilled nursing facility care, hospice care, and home healthcare. Most people don’t need to pay a Part A monthly premium because they (or their spouse) already contributed while working. Medicare Part B covers doctors’ services and other outpatient care. There is a monthly premium for Part B. The purchase of Part B is optional, and there may be a late enrollment penalty.
What Medicare Parts A and B do NOT cover
In addition to Original Medicare’s copayments, coinsurance, and deductibles, you will also have to pay for services that are not covered by Original Medicare, including but not limited to:
• Custodial care (help with bathing, dressing, eating, and using the bathroom) unless it is part of skilled nursing or hospice care
• Long-term care
• Orthopedic shoes
• Most prescription drugs
• Syringes or insulin, except insulin used with an insulin pump
• Care you receive while traveling outside the United States
Medicare Parts A and B
Original Medicare Medicare Part C
Medicare Advantage
Medicare Part Callows you to get Medicare coverage through a private insurer. Generally, you must use plan providers except in emergency or urgent care situations.
Medicare Advantage plans can:*
• Simplify your coverage, with only one benefit plan and one membership card.
• Provide the same benefits as Original Medicare Parts A and B.
• Offer additional benefits.
• Have different cost-sharing than Original Medicare.
• Offer out-of-pocket cost limits on some services.
• Provide Part D prescription drug coverage.
• Have provider networks.
• Have a monthly premium in addition to the Part B premium.
* Confirm what your local insurers offer for Medicare Advantage to see whether it fits your needs.
Creditable Coverage
Prescription drug coverage that is at least as good as Medicare Part D coverage is called “creditable coverage.”
If you don’t have creditable coverage when you first become eligible for Medicare and do not enroll in a Medicare Part D plan, you could pay a penalty (higher monthly premiums) when you do enroll in prescription drug coverage later on.
If you have questions about creditable coverage, contact Medicare. (See page 14 for contact information.)
Medicare Part D is optional coverage that includes prescription drugs not covered under Original Medicare Parts A or B. The 2015 out-of-pocket maximum for drug costs will be $4,700.
There are two ways to get Part D coverage:
• A stand-alone Medicare Prescription Drug Plan (called a “PDP”)
• As part of a Medicare Advantage plan (called an “MA-PD”)
In general, most plans have:
• A monthly premium
• A formulary of covered drugs
• A deductible
• Copayments and/or coinsurance
• A pharmacy network
Medicare Part D
Prescription Drug Plan Medicare Supplement Plans
Medicare Supplement Plans (“Medigap”) offer coverage that fills the gaps in Original Medicare (Parts A and B). These Medigap Plans, like Medicare Advantage plans, are offered through private insurers. Depending on the policy, Medigap plans cover part or all of the deductibles, copayments, and coinsurance under Original Medicare. They offer the flexibility of being able to go to any Medicare
participating provider. And there are several standardized plan options to choose from, but not every insurer offers all of them.
With Medigap plans, you:
• Must have Original Medicare (Parts A and B).
• Must pay the Part B monthly premium.
• Cannot be enrolled in a Medicare Advantage plan.
• Can enroll in a Medicare Part D prescription drug plan separately.
To Summarize Your Options
For Medicare Coverage
There are two basic ways to get Medicare coverage:
What Do I Need To Consider
About My Medicare Eligibility?
1
2
You May Choose A
Medicare Advantage Plan
• Medicare Part C is offered by BCBSRI and other companies.
• Provides more coverage than Parts A and B (Original Medicare).
• Most plans provide Part D prescription drug coverage.
• May include additional benefits.
• May offer lower copayments than Original Medicare with no deductibles.
• May require you to get care within a network of doctors and other healthcare providers.
You May Choose
Original Medicare With Options
Medicare Part A Hospital Insurance Medicare Part B Medical Insurance Options you may add: Medicare Part D
Medicare Prescription Drug Plan Medicare Supplement
Medigap Policy
When am I eligible for Medicare?
As long as you’re a U.S. citizen or permanent resident of the U.S., you’re eligible for Medicare when:
• You’re age 65 or older, or
• You have received disability benefits from the Social Security Administration or the Railroad Retirement Board for at least 24 months.
When can I enroll in Medicare?
You can enroll in Medicare Parts A and B (and other Medicare plans) anytime during the Initial Coverage Election Period, which is the three months before your birth month, the month you turn 65, and the three months after your birth month. If you apply during the three months before the month you turn 65, you’ll be covered starting on the first day of the month you turn 65. If your birthday falls on the first of the month, your Medicare coverage will take effect the first of the previous month.
Please note: The full retirement age for Social Security is going up, and you may not be eligible until you are 67. This has an effect on how your Part B premium is paid.
For example, if you are not receiving Social Security benefits, you are responsible for the Part B premium costs. If you are receiving Social Security benefits, your premium for the Part B coverage will be deducted directly from your Social Security benefits. (See page 14 for contact information.)
Not Ready to Retire
Talk with your employer or union about your options. If you intend on working and your employer has 20 or more employees, they must offer you (and your spouse, if he or she is over age 65) the same coverage as employees who are under age 65. Even if your employer has fewer than 20 employees, they may provide additional coverage for you.
Note: If you are turning 65 but your spouse is younger, he or she may be able to continue coverage under your employer’s plan; however, you may be responsible for the entire cost. You should contact your benefit administrator for more information. So why wait to learn more about the coverage you need to live life to the fullest?
Spend Significant Time Outside
of Rhode Island
If you spend a significant part of the year in a second home (for example, if you “fly south” for the winter), you need Medicare coverage that will travel with you. Check to make sure the plans you are considering allow you to receive coverage outside of their service area. Original Medicare, Medigap plans, and some Medicare Advantage plans will cover services throughout the United States. However, if you are enrolled in a Medicare Advantage plan, you cannot be outside the plan’s service area for more than six months.
If you plan to travel outside the United States, you
Choices For Special Situations
Do you plan to keep working? Do you plan to spend your retirement
traveling the globe or just traveling someplace warm for the winter?
Make sure you choose Medicare options that can keep up with you!
Decision-Making Checklist
It’s helpful to gather the following information so you can
truly compare all your options.
✓
✓
✓
✓
Get plan information.
Use the resources on page 14 to find out what Medicare Advantage, Medigap, and Medicare Prescription Drug Plans are available in your area. Contact the plans to get benefit and cost information.
Make a list of your doctors and pharmacy.
Check to see if they participate in the networks of any plans you’re considering.
Make a list of your healthcare needs.
What healthcare services do you need regularly?
Are you anticipating any special needs, such as surgery? Use this list to compare coverage and out-of-pocket costs for the plans you’re considering.
Make a list of your medications.
Use this list to determine which Medicare Prescription Drug Plan is best for you. Check each plan’s formulary to make sure the drugs are covered, and compare out-of-pocket costs.
Your Medicare Timeline
Important Dates
12 Months before your
65
thbirthday 6 Months before your
65
thbirthday 5 Months before your
65
thbirthday
Now is the time to start looking into your Medicare plan options.
Contact Social Security to find out about eligibility and enrollment.
(See page 14 for contact information.)
Contact Medicare and/or Blue Cross & Blue Shield of Rhode Island for more information, including specific benefits and costs. (See page 14 for contact information.)
Talk with family, friends, and doctors about your options. Talk with your employer
about available group coverage.
Narrow down your options for coverage. Make sure plans will cover
you if you travel frequently or spend significant time outside Rhode Island. Make sure plan networks
include your doctors and pharmacy.
Compare out-of-pocket costs between plans.
MONTH/DAY MONTH/DAY MONTH/DAY
____________________________ ___________________________ __________________________
3 Months before your
65
thbirthday 2 Months before your
65
thbirthday 65
th Birthday
Congratulations! Now you can apply for Medicare benefits through the Social Security Administration. (See page 14 for
contact information.) You can also apply
for any additional coverage now.
Decide whether you want coverage in addition to Medicare Parts A and B. Let your employer know
about your decisions to ensure a smooth transition from group coverage to Medicare/ retiree coverage.
If your spouse was covered under your employer’s plan, make arrangements for him or her to have coverage after you have Medicare.
Happy Birthday!
Now it’s time to make sure everything is in place.
Check that you have your Medicare card.
Make sure you have cards for any additional coverage you enrolled in.
Tell your doctors and pharmacy about your new coverage.
MONTH/DAY MONTH/DAY MONTH/DAY
__________________________ ____________________________ ____________________________
Social Security Administration
Get information and publications about enrolling in both Social Security and Medicare; apply for extra help with Medicare prescription drug costs. Call: 1-800-772-1213TTY: 1-800-325-0778 Online: www.ssa.gov
Blue Cross & Blue Shield
of Rhode Island
Our knowledgeable sales representatives can provide information about all of our Medicare plan options.
You can speak with them by phone, in person at our Warwick and Bristol locations, or at any of our community informational seminars.
Call: 1-888-251-2304 TTY/TDD: 711
Hours: Monday – Friday, 8:00 a.m. to 8:00 p.m. (open 7 days a week, 8:00 a.m. to 8:00 p.m., from October 1 – February 14) Visit Us:
300 Quaker Lane, Warwick (Cowesett Corners shopping center)
576 Metacom Avenue, Unit 18, Bristol (Bell Tower Plaza)
Hours: Monday – Friday, 9:00 a.m. to 5:00 p.m.
Medicare
Find general information about Medicare, get copies of Medicare publications, and learn more about your options.
Call: 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048
24 hours a day, seven days a week Online: www.medicare.gov
Rhode Island Department
of Elderly Affairs
Get information about your Medicare options, including the publication, Rhode Island Guide to Buying Medicare Supplement Insurance and Medicare Advantage Plans. The Department of Elderly Affairs runs the Rhode Island Senior Health Insurance Program, where you can get free counseling at community locations across Rhode Island.
Call: (401) 462-3000 TTY: (401) 462-0740 Online: www.dea.ri.gov
Your Employer
Talk to your employer’s benefit administrator to learn more about your Medicare options, including whether you can continue your group health coverage or whether your employer offers a group retiree plan.
• We’re committed to quality and customer service. For 2015, we received an overall rating of 4 Stars from the Centers for Medicare and Medicaid Services (CMS) Five-Star Quality Rating System. This system is a rating of health plans’ quality and performance. Medicare evaluates plans based on a 5-star rating system. Star Ratings are cal- culated each year and may change from one year to the next.
• As a BlueCHiP for Medicare member, you’ll have exclusive access to the BlueCHiP for Medicare Concierge Team. This dedicated team of BCBSRI representatives can
answer questions about your medical benefits, claims, and medical conditions, help you find resources and programs to stay healthy, and more.
• A name you know—1 in 3 Americans is covered by a Blue Cross and Blue Shield plan.* We’ve been serving the Rhode Island community for over 75 years and offering Medicare Advantage plans since 1997.
• Our Medicare Advantage plans have an extensive network of doctors and other healthcare providers.
• We have comprehensive programs to help you manage your health, including care coordinators who can help you manage chronic conditions such as diabetes, heart disease, and asthma.
• You have access to bcbsri.com/Medicare, where you can review your claims and benefits, find tools and re- sources to stay healthy and save money, and more.
Learn More About Medicare
Turn to these resources to find out all you can about your
Medicare options.
As a Rhode Islander, You Have
Several Options for Private
Medicare Coverage
Why Choose Blue Cross & Blue Shield of Rhode Island?
500 Exchange Street • Providence, RI 02903-2699
Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Enrollment in Blue Cross & Blue Shield depends on contract renewal.
Questions?
We’re Here To Help.
Give Us a Call.
We’re On Call.
Our representatives are available if you have questions or need help evaluating your options.
1-888-251-2304 (TTY/TDD: 711)
Hours: Monday – Friday, 8:00 a.m. to 8:00 p.m. (open 7 days a week, 8:00 a.m. to 8:00 p.m., from October 1 – February 14)
Visit Us:
300 Quaker Lane, Warwick (Cowesett Corners shopping center) 576 Metacom Avenue, Unit 18, Bristol (Bell Tower Plaza)
Hours: Monday – Friday, 9:00 a.m. to 5:00 p.m.
(Extended hours, October 1 – March 1: Monday until 6:00 p.m.; Saturday, 9:00 a.m. to 1:00 p.m.)
Online: bcbsri.com/Medicare
