Sandy D’Elia, senior director of Medicare Sales for Blue Shield of California, explains important points in understanding Medicare and how Californians can get ready for the Medicare Annual Election Period (AEP).
What are Medicare Parts A, B, and C and who is eligible?
Generally, Medicare Parts A, B, and C are available for people age 65 or older, younger people with disabilities, and people with end- stage renal disease (permanent kidney failure requiring dialysis or transplant).
Original Medicare has two parts, Part A (Hospital Insurance) and Part B (Medical Insurance). Alternatively, Part C (Medicare Advantage) is an “all-in-one” plan offered by private insurance companies, such as Blue Shield of California. Part C includes Part A and Part B coverage, and usually prescription drug coverage (Part D), too. Specifically:
- Part A (Hospital Insurance) – You are eligible for Part A if you are age 65 or older and you or your spouse worked at least 40 quarters or 10 years. If you meet the criteria, there is no cost for Part A. People with fewer than 10 years worked may still be eligible but will have to pay a premium. To find out if you are eligible and whether you need to pay a premium, go to the Medicare.gov eligibility tool.
- Part B (Medical Insurance) – If you are eligible for Part A, you are also eligible for Part B. However, you must pay a monthly premium for Part B coverage (typically deducted from your Social Security check). Special rules apply for people who don’t have 10 years of Medicare credit.
- Part C (Medicare Advantage)*****: To be eligible for Part C, known as Medicare Advantage, you must:
- Be enrolled in Original Medicare (both Medicare Parts A and B).
- Live in the service area of the Medicare Advantage plan you want to enroll.
- Be a United States citizen or be lawfully present in the United States.
What is the difference between a Medicare Advantage (Part C) plan and a Medigap (or Medicare Supplement) plan?
While Original Medicare (Parts A and B) covers many healthcare expenses, it doesn’t cover everything so there can be significant out-of-pocket costs. It’s important to remember that there is no out-of-pocket maximum with Original Medicare.
You have two options to help with costs not covered by Original Medicare.
- You can enroll in a Medicare Advantage (Part C) plan offered by a private insurance company such as Blue Shield of California. Medicare Advantage plans may offer extra benefits beyond Original Medicare including Part D prescription drugs, vision care, over- the-counter items allowance, and other benefits that suit your needs. In most cases, Medicare Advantage plans use a network of physicians and hospitals and have copays and/or coinsurance for covered services. There is an annual out-of-pocket maximum to help make your health care costs more predictable.
- You can supplement Original Medicare with a Medigap policy, also known as a Medicare Supplement plan. These plans typically pay the costs that Original Medicare doesn’t fully cover. You’ll also need to buy prescription drug coverage separately, known as a Medicare Prescription Drug Plan (Part D or PDP), since Original Medicare doesn’t cover prescription drugs. Medicare Supplement plans offer more flexibility than Medicare Advantage plans. You can go to any doctor or hospital, as long as they accept Medicare.
What if I am turning 65 and now eligible for Medicare? When can I enroll?
Your initial enrollment period begins three months prior to your 65th birthday, includes the month you turn 65, and ends three months after your birthday month. If you miss your initial enrollment period, you likely will have to enroll during either a Special Enrollment Period (SEP) (if you qualify) or during the next Annual Election Period (AEP).
What is Annual Election Period (AEP) and how long do I have to make a decision?
The Annual Election Period (AEP) is the open enrollment period for Medicare beneficiaries to sign up for Medicare Advantage and Medicare prescription drug plans. The AEP runs from October 15 to December 7 every year. This period is your opportunity to enroll in a new plan or switch or make changes to your existing plan, unless you qualify for a Special Election Period (SEP) that allows you to enroll outside of the normal AEP timeframe. You have until 11:59 p.m. on December 7 of each year to make your selection. Selections made during the AEP are effective as of January 1st of the following year.
What makes Blue Shield of California Medicare plans a good value?
Blue Shield of California offers a complete portfolio of Medicare products to suit your health care needs and budget.
In addition to the standard benefits, our Medicare Advantage plans* offer supplemental benefits such as monthly allowances for over-the-counter items, transportation services to plan-approved health related locations, and a Personal Emergency Response System. Healthy Grocery, a Special Supplemental Benefit for the Chronically Ill (SSBCI)**, is also available to eligible members. You can visit www.bsca.com/medicare to explore plan options.
Can I choose my own doctor if I join a Blue Shield plan?
When joining one of our Medicare Advantage Plans, you will have the opportunity to choose from a diverse and broad network of providers who contract with Blue Shield to coordinate and provide covered services to plan members.
When selecting one of our Medicare Supplement plans, you are able to choose any physician or hospital anywhere in the US as long as they accept Medicare. Blue Shield Medicare Supplement plans are available to residents in all 58 counties in California***.
Are prescription drugs covered and is there a premium?
When enrolled in a Medicare Advantage plan that offers Part D prescription coverage, you have pharmacy benefits embedded in the plan. Depending on the plan, there may or may not be a plan premium or deductible.
When selecting a Medicare Supplement plan, you must purchase a separate Part D prescription drug plan (PDP). These Part D plans range in premiums and coverage options. Blue Shield of California offers Part D plans and can help you select one that meets your needs.
How can I get ready for AEP?
There are several steps you can take to get ready for the upcoming AEP, which runs from October 15 to December 7.
- Understand your current health care coverage.
- Determine if your medical and/or budget needs have changed year over year.
- Discuss your needs with a trusted broker or health plan representative to help guide your Medicare options.
- Study those options accordingly and decide what best fits your needs.
- Select your plan type and enroll prior to December 7.
For more information on Medicare options, you can visit www.medicare.gov. If you would like to learn more about Medicare Advantage, Medicare Supplement plans, and/or prescription drug plans offered by Blue Shield of California, please visit www.bsca.com/medicare or call (800) 488-8000 [TTY: 711], 8 a.m.- 8 p.m. seven days a week from October 1st through March 31st****.
*Benefits vary by plan and by service area.
**The benefits mentioned are part of special supplemental benefits available in select plans. Not all plan members will qualify. Refer to the Evidence of Coverage for details and eligibility requirements.
***All Blue Shield of California Medicare Supplement plans are offered statewide, with the exception of Plan G Inspire, which is offered in select Northern California counties only.
**** From April 1st through September 30th, hours of operation are 8 a.m.- 8 p.m. Monday-Friday.
*****Source: U.S. Department of Health and Human Services and www.cms.gov