If you’re about to turn 65, you’ve probably been receiving brochures and letters about Medicare. Recipients are eligible to enroll 3 months before, during the birthday month and 3 months after.
Many companies are on the market, but one name you are probably familiar with is Blue Cross Blue Shield. Blue Cross Blue Shield has been in the health insurance business for 90 years, so it’s a credible and reputable company. If you’re not familiar with Blue Cross, we’ve gathered some facts you should know.
What is Medicare?
Medicare is a federally-funded health insurance program geared toward people ages 65 and up who are U.S. citizens and who have paid Medicare taxes throughout their careers. It’s also available to disabled individuals under the age of 65 who receive Social Security Disability benefits.
Medicare is divided into 4 parts:
Part A: Covers inpatient hospital care, skilled nursing care and some home care.
Part B: Covers doctor visits, outpatient care, and medical equipment. Part B’s monthly premium is based on your annual income and is often deducted from your Social Security withholdings. This premium is separate from health insurance premiums you’ll pay if you choose a Medicare Advantage, Medigap, or Part D plan.
Parts A and B are also known as Original Medicare.
Part C: Also called Medicare Advantage plans, these are offered by private insurers and cover care not usually provided with Original Medicare.
Part D: Prescription drug plans offered by private insurance companies. Original Medicare doesn’t cover prescription drugs.
You can also buy medical supplemental insurance plans, known as Medigap plans. Medical supplemental plans fill in gaps not covered by Original Medicare and are offered by private insurers. If you don’t choose a Medicare plan within the short 7-month window, you could pay a financial penalty.
The Centers for Medicare and Medicaid Services (CMS) is the government agency that oversees all Medicare plans. CMS sets guidelines private insurers must follow regarding plan features, marketing, quality and pricing. CMS rates plans from 1–5 stars with 5 stars being the highest in areas such as provider choice, performance, customer service and quality. Plans that violate CMS policies can be suspended or terminated, and insurers can be fined.
Who’s Blue Cross Blue Shield Medicare For?
You’re eligible for Blue Cross Blue Shield Medicare if you are:
- About to turn 65, just turned 65 and up to 3 months after your birthday
- Deemed disabled by the Social Security Administration and collecting disability benefits; can be under the age of 65
- An individual or spouse seeking a Medicare Advantage plan
- An employee turning 65 still working; can choose a Medicare Advantage group plan through employer
- Paid Medicare taxes and a U.S. citizen
Blue Cross Blue Shield Medicare Coverage Selections
Blue Cross Blue Shield offers several types of Medicare Advantage plans, including:
HMO plans: These plans are made up of regional networks of doctors, hospitals, and specialists who all agree to charge specific rates and copays. You’ll need to choose a primary care doctor who will give you referrals to see specialists. You must stay within Blue Cross’ HMO network or pay full price for care and services. HMOs focus on health and wellness, so you’re encouraged to maintain a healthy weight, keep your blood pressure at a normal rate, limit alcohol and refrain from smoking. For an extra $24 per month, you can purchase optional dental, hearing and vision coverage with your plan.
HMO Point-of-Service plans: These plans, also called HMO-POS plans, are hybrids of HMO and PPO plans. You still need to choose a primary care doctor and get referrals, but you’ll get cost coverage similar to a PPO plan. You’ll also get more coverage if you use a preferred provider and pay more if you use one who is out-of-network.
PPO plans: These plans are usually costlier than HMO plans but feature more benefits. You can see any doctor you like but will pay less if you choose one in-network. Also, no referrals are needed if you want to see a specialist. PPOs are made up of large networks of hospitals and providers who’ve agreed to charge predetermined rates for services. If you choose a provider or hospital outside of the PPO network, you’ll pay substantially more. Blue Cross’ PPO plans offer optional dental and vision coverage for a nominal monthly fee.
Medicare Supplement or Medigap plans. Blue Cross offers Medicare Supplement plans that cover many out-of-pocket expenses not paid for by Original Medicare.
Part D or prescription drug plans: These are standalone plans that complement Original Medicare or Medicare Advantage plans.
Pricing and Value
Blue Cross Blue Shield makes it easy for you to compare plans on their website. You simply answer a few questions about your age, location, health status and needs, and you’ll be presented with several different plan options.
Here are some examples for someone age 65, in good health, living in Michigan, looking for plans with drug coverage:
|Plan Name||Plan Type||Medical Deductible||Monthly Premium||Total Estimated Cost||Star Rating|
|MedicarePlus Blue Essential||PPO||$160||$9||$1,352||4|
|MedicarePlus Blue Vitality||PPO||$65||$76||$2,048||4|
|MedicarePlus Blue Signature||PPO||$0||$134||$2,577||4|
|MedicarePlus Blue Assure||PPO||$0||$298||$4,149||4|
All of the above plans come with free fitness programs, health and wellness incentive programs and optional dental and vision coverage (HMO plans also offer hearing coverage, but PPO plans do not).
Note: The total estimated costs are based on your medical and drug costs, depending on your plan type, plus your premium.
Some people consider one of the best ways to choose a plan is going for the lowest dollar amount as the best value. You need to consider how many prescription drugs you need, how important keeping your current doctor is as well as how much you can afford in determining the best plan for you.
You can reach customer service representatives at Blue Cross Blue Shield during normal business hours Monday through Friday by calling 888-630-2583. You can also visit its website and ask questions using a virtual assistant. When you talk to customer service, you can get more information about plans by inquiring about seminars in your area or having a licensed sales agent contact you.
Blue Cross’ website is also a great resource for:
- Estimating the cost of a health service
- Finding a doctor or pharmacy
- Filing a claim
- Reviewing your balance
- Changing your coverage
- Reviewing your plan details
- Checking a claim status
- Accessing your benefits and services
- Replacing your member ID card
You can go paperless and opt to have all of your benefits and claims information sent to you through your online account portal, as well as download a mobile app that includes a virtual ID card so you’ll always have it on hand.
In most cases, the doctor, hospital or specialist you see will file a claim with Blue Cross, however, in some cases you might have to file a claim. If a provider doesn’t take your insurance or can’t verify your coverage, you’ll file a claim. Also if you receive care while traveling outside the U.S. you must file a claim.
To file a claim, you can fill it out and mail it or file it online. You can check the status of your claim by phone or by logging in to your member account.
Shop Around for the Best Medicare Plans
Two of Blue Cross Blue Shield’s plans were among the top 10 picks in J.D. Power’s 2019 Medicare Advantage Study. The study measured plans in areas such as overall satisfaction, billing and payment, cost, provider choice, coverage and benefits, and customer service.
Blue Cross’ plans were also top-ranked in U.S. and World Report’s Best Insurance Companies for Medicare Advantage 2019. Even with raving reviews, it makes sense to shop around and compare plans before you make your final decision.
Shopping for a Medicare plan is just as important as shopping for a new car or home, so visit sites like Medicare.gov, J.D. Power and Benzinga.com to learn more about the pros and cons of each plan before you enroll.