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Medicare Supplement - Over 65

Supplemental insurance (Medigap) helps pay the excess costs Medicare does not: covers the gaps in Medicare.

How Does Medicare Work?
Medicare has four basic parts that help with health care costs. Each part provides coverage for different types of health care services.
  • Part A: Hospital insurance
  • Part B: Medical insurance
  • Part C (Medicare Advantage): Includes Parts A and B, sometimes Part D
  • Part D: Outpatient prescription drugs

Parts A and B are sometimes known as “Original Medicare.” Keep in mind that original Medicare was not designed to cover all your medical expenses.

  • Medicare Supplement insurance¹: This optional coverage helps to pay for expenses beyond what is covered by Medicare. There are several Medicare Supplement insurance plans, each with different benefits and premiums, so you can choose the plan that works best for your specific needs. Medicare Supplement insurance plans are identified by the separate letters A, B, C, D, F, F-HD, G, K, L, M and N. The basic benefits of each plan are exactly alike for all insurance companies.
  • You cannot have a Medicare Supplement Insurance Plan and a Medicare Advantage Plan at the same time. If you have a Medicare Supplement Insurance Plan and decide to join a Medicare Advantage Plan, you will have to drop your Medicare Supplement Insurance Plan.

 

Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.

Medicare Supplement Insurance plans are offered by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross Blue Shield Association.

When are you eligible for Medicare?

If you answer YES to at least one of the following questions, you may be eligible.

  • Are you age 65 or older and have Social Security or Railroad Retirement Board benefits?
  • Are you under age 65 with certain disabilities?
  • Do you have ALS (amyotrophic lateral sclerosis) or, at any age, End-Stage Renal Disease?
  • Have you or your spouse worked for at least 10 years in Medicare-covered employment?

In order to be eligible for a Medicare Supplement insurance plan, or a Part C or Part D plan, you must be enrolled in Medicare Part A and Medicare Part B.

You must continue to pay your Medicare Part B premium.

Medicare Part C - Medicare Advantage Plans

Medicare Advantage plans sometimes called “Part C” or “MA Plans,” are offered by private insurance companies.

 

Medicare Advantage is a program that offers other health plan options that pay for original Medicare-covered services (Parts A and B) plus additional benefits and services such as:

  • Health maintenance organizations (HMOs)
  • Preferred provider organizations (PPOs)
  • Private fee for service (PFFS) plans
  • Special needs plans (SNPs)

 

How Medicare Advantage Plans Work
  • The funds paid by the federal government to these private health insurers are used to pay the doctors, specialists and hospitals that you use; however, the care is managed by the private health insurers.
  • The private health insurers may also offer supplemental benefits not covered by original Medicare such as vision, hearing, chiropractic care and more.
  • Plan members usually are directed toward a network of doctors, hospitals and other health care professionals to receive services, but are not required to use those professionals.

 

Medicare Advantage Plans – Costs

In a Medicare Advantage plan, you may pay a monthly premium as well as copayments – which are usually a fixed amount – when you receive services. The Medicare Advantage premium includes coverage for Medicare Part A and Medicare Part B benefits, prescription drug coverage (if offered) and any other benefits allowed by the plan. You will also continue to pay your Medicare Part B premium while enrolled in Medicare Advantage.

 

Medicare Advantage Plans – Drug Coverage

Health insurers offering Medicare Advantage plans generally must provide at least one plan with basic prescription drug coverage, but most offer multiple options. If you choose a Medicare Advantage plan that offers prescription drug coverage, you must receive your benefits through that plan, rather than enrolling in a separate Medicare prescription drug plan.

 

Medicare Advantage Eligibility

If you answer “yes” to at least one of the following questions, you may be eligible.

  • Are you age 65 or older and have Social Security or Railroad Retirement Board benefits?
  • Are you under age 65 with certain disabilities?
  • Do you have ALS (amyotrophic lateral sclerosis) or, at any age, End-Stage Renal Disease?
  • Have you or your spouse worked for at least 10 years in Medicare-covered employment?

In order to be eligible for a Medicare Supplement insurance plan, or a Part C or Part D plan, you must be enrolled in Medicare Part A and Medicare Part B.

Looking for more information? Click here.

Medicare Part D - Medicare Prescription Drug Coverage

Medicare Prescription Drug Plans are approved by Medicare and designed to cover your outpatient and maintenance prescription drugs. It enhances your Original Medicare and/or Medicare Supplement insurance coverage. Even if you don’t take any prescription drugs, consider enrolling in a prescription drug plan when you become eligible. You want to protect your health and finances and be covered if your situation changes.

 

How Medicare Prescription Drug Coverage Works

Medicare Part D helps you pay for your prescription drugs. Because Part D is a government program, the Centers for Medicare and Medicaid Services (CMS) closely oversee every aspect of the program. Every detail, from the drug list (also called the formulary) to how an insurance company sells its plans, is reviewed and approved by CMS.

Before an insurance company can sell Medicare Part D coverage, it must have its proposed benefits, premiums and the drug list approved by CMS. This makes sure the coverage follows federal guidelines and it protects you as a Medicare beneficiary.

 

Medicare Part D Eligibility

If you answer “yes” to at least one of the following questions, you may be eligible.

  • Are you age 65 or older and have Social Security or Railroad Retirement Board benefits?
  • Are you under age 65 with certain disabilities?
  • Do you have ALS (amyotrophic lateral sclerosis) or, at any age, End-Stage Renal Disease?
  • Have you or your spouse worked for at least 10 years in Medicare-covered employment?

In order to be eligible for a Medicare Supplement insurance plan, or a Part C or Part D plan, you must be enrolled in Medicare Part A and Medicare Part B.

 

The four phases of Part D prescription drug plans

All Part D plans, have the phases below. Benefits offered within the plans can vary.

  • Annual Deductible: You pay this amount for your prescriptions before the private insurance company you choose begins to pay.
  • Initial Coverage: You pay a copay or coinsurance for each eligible prescription filled.
  • Coverage Gap: You pay your prescription drug costs until you reach a year-to-date True Out-Of-Pocket (TrOOP) cost (payments including deductibles, copays, coinsurance). During this time, you may be eligible for a discount on brand name drugs and a discount on generic drugs at the time of purchase.
  • Catastrophic Coverage: You pay a copay for generics, a copay or coinsurance (whichever is greater) for other drugs, and coinsurance for specialty drugs after TrOOP costs are reached.

Looking for more information? Click here.

What is a Medicare Supplement insurance plan?

Medicare is the nation’s largest health insurance program, covering things such as hospital stays, skilled nursing, and physician services. But Medicare was never meant to pay for everything. That is why Blue Cross and Blue Shield of Illinois (BCBSIL) offers Medicare Supplement insurance plans – to help fill in the gaps that Medicare may not cover and leave you better protected.

 

How do Medicare Supplement insurance plans work?

Medicare Supplement insurance plans are offered by private health insurance companies and work together with Original Medicare. While Medicare will pay for many of your health care costs, Medicare Supplement insurance plans may help cover things that original Medicare does not, such as:

  • deductibles
  • copays
  • coinsurance

 

Why do I need a Medicare Supplement insurance plan?

A Medicare Supplement Insurance Plan can protect you from some unexpected costs you may receive while using your Original Medicare coverage. In addition, many Medicare Supplement insurance plans offer coverage when traveling outside the United States, which Original Medicare does not.

1 Not connected with or endorsed by the U.S. Government or Federal Medicare Program.

* Plans K-N provide for different cost-sharing than plans A-G. Plans K and L pay 100% of hospitalization and preventive care Basic Benefits. All other Basic Benefits are paid at 50% (Plan K) and 75% (Plan L). Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called “excess charges.” You are responsible for paying excess charges.

 

Plan N covers Basic Benefits after a $20 copay for office visits and a $50 copay for emergency room visits.

 

** The out-of-pocket annual limit may increase each year for inflation. (2016 limits shown)

 

Network restrictions apply.

 

Put your mind at ease knowing that with Blue Medicare Supplement insurance plans, your health care coverage is with a financially stable and recognized leader serving Illinois for more than 75 years.

 

Take note: If you choose a Blue Medicare Supplement insurance plan, you will need a separate prescription drug plan because Medicare Supplement insurance does not include prescription drug coverage.

 

Save Money with a Medicare Select2 Option

Medicare Select is an option available on most of Blue Medicare Supplement insurance plans. This option helps you save on premiums when you agree to use the hospitals in the Medicare Select Network for non-emergency elective admissions. You get the same solid benefits as our “standard” plans, but your premiums will cost less. This option is not available for Plan A and High Deductible Plan F.

 

2 Network restrictions apply.

When do I enroll?

If you are nearing 65, you can enroll in Medicare during the seven months of the initial enrollment period. The initial enrollment period includes the three months before your 65th birthday, the month of your 65th birthday and the three months after the month of your 65th birthday.

 

Medicare Part A: Hospital Insurance
  • If you are getting benefits from Social Security, you automatically get Part A benefits starting the first day of the month that you turn 65.
  • You will receive a package of information from Medicare at the beginning of your initial Medicare enrollment period.
  • The package will contain your Medicare card and information about your benefits.
  • For most people, Medicare Part A is free.

 

Medicare Part B: Medical
  • There are three opportunities to sign up for Part B: the initial Medicare enrollment period, the special Medicare enrollment period and the general Medicare enrollment period.
  • If you or your spouse are still working and are enrolled in a group health plan, you may decide to delay enrolling in Part B until you retire. This is because you may have “Creditable Coverage”; check with your employer benefits administrator to see if this applies to you. Then you may be eligible for the “Special Enrollment Period” once you retire.

There are three enrollment periods for Medicare.

 

Initial Enrollment Period General Enrollment Period Special Enrollment Periode
Who is eligible? People turning 65 or have been receiving Social Security Disability benefits for 24 months People who missed the Initial Enrollment Period or declined or canceled Medicare Part B coverage and did not have any other coverage People who have employer or union medical benefits or dropped prior Part B coverage to return to work. COBRA and retiree health plan participants are not eligible for a Special
Enrollment Period.
When is the enrollment period? Seven months that include:
• 3 months before your 65th birthday month
• Your 65th birthday month
• 3 months after your 65th birthday month
Seven months that include:
• The monthly premium goes up 10 percent for each 12-month period that you could have had Medicare, but didn’t take it.
• The penalty increases as Medicare premiums increase.
• Your 65th birthday month
• 3 months after your 65th birthday month
January 1 to March 31 each year
During this time, you may enroll in Part B, but your benefits will not go into effect until July 1 of the same calendar year.
What is the late enrollment penalty? • The monthly premium goes up 10 percent for each 12-month period that you could have had Medicare, but didn’t take it.
• The penalty increases as Medicare premiums increase.
No penalty if you enroll within the 8-month window

 

Medicare Supplement Insurance Plan Notice:

 

Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.

 

Medicare Supplement Insurance plans are offered by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross Blue Shield Association.

Want more information? Contact K&B.

Important Anti-Discrimination Information

You must continue to pay your Medicare Part B Premium. This information is not a complete description of benefits. Contact the plan for more information. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year. Limitations, co-payments, and restrictions may apply. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

Medicare Part D Plan Notice: Prescription drug plan provided by Blue Cross and Blue Shield of Illinois, which refers to HCSC Insurance Services Company (HISC), an Independent Licensee of the Blue Cross and Blue Shield Association. A Medicare-approved Part D sponsor. Enrollment in HISC’s plan depends on contract renewal.

This information is available for free in other languages. Please call the plan customer service number at 1-877-213-1821 TTY/TDD 711. They are open between 8:00 a.m. and 8:00 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

En Espanol: Esta información está disponible en otros idiomas de forma gratuita. Comuníquese a nuestro número de Servicio al cliente al 1-877-774-8592 (los usuarios de TTY/TDD deben llamar al 711). Nuestro horario es de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y feriados, se usarán tecnologías alternas (por ejemplo, correo de voz).

Medicare Advantage Plan Notice: HMO, HMO-POS and PPO plans available in Cook, DuPage, Kane and Will counties. HMO, HMO-POS and PPO plans are provided by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC’s plans depends on contract renewal.

Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.

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