Get to know the ABCDs of Medicare

Medicare was established in 1965 to help people who are 65 and over or have disabilities pay for the rising costs of medical care. Over the years, it has changed. Whether you are new to Medicare or want a refresher, here are a few resources to help you understand the costs, benefits, and choices offered by Blue.

Eligibility for Medicare

You are generally entitled to Medicare if you meet any of the following criteria:

  • You are age 65 or above.
  • You already receive Social Security or Railroad Retirement Board (RRB) benefits.
  • You have been diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, “Lou Gehrig’s disease”).
Your Initial Enrollment Period is based on the month in which you turn 65. It begins three months before your birth month and extends until three months after your birth month.
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Original Medicare (Part A and Part B)
Medicare Part A is offered at no cost to most people eligible for Medicare. Medicare Part B is available for a monthly premium to most people eligible for Medicare. Medicare premiums, deductibles and cost-sharing amounts are set by the federal government each fall for the next year.

Part A: Hospital Coverage 

Medicare Part A help pays for:
- Inpatient hospital stays
- Care in a skilled nursing facility
- Home health care and hospice care
You pay a share of the costs because of things like day limits, deductibles and coinsurance.

Part B: Medical Coverage 

Medicare Part B covers:
- Doctor's services and tests
- Outpatient care
- Durable medical equipment and some medical services
- Supplies not covered by Medicare Part A.
Part B also covers some preventive services.

Doesn't cover deductibles, copays and coinsurance.

Medicare Advantage (Part C)
With a Medicare Advantage plan you get Medicare Part A and Part B benefits and some plans may offer extra benefits. Some Medicare Advantage plans also include prescription drug coverage in one plan. Like all Medicare plans, benefits, premiums and co-payments may change from year to year.

Part C: Medicare Advantage 

With a Medicare Advantage plan you get:
- Medicare part A and Part B benefits
- Some plans may offer extra benefits

If you go to a doctor or other healthcare provider that does not belong to your plan’s network, your services may not be covered or your costs could be higher.

Medicare Advantage plans also require cost sharing such as coinsurance, copays and deductibles.

Prescription Drug Plans (Part D)
Medicare works with health plans and other private companies to offer prescription drug coverage. These Medicare-approved plans are called standalone Part D plans.

Part D: Prescription Drug Plans 

Part D covers:
- Generic drugs
- Brand name drugs

Not all Plans have the same formulary (the list of covered drugs) and you will need to use a network pharmacy to ensure your drugs are covered.

Medicare Supplement Plans (Medigap)
Medigap plans are sold by private health coverage companies. They help pay for some of the health care costs or “gaps” that Medicare Part A and Part B don’t cover. In most cases, you must have both Medicare Part A and Part B to purchase a Medigap policy.

Medicare Supplement Plans (Medicap) 

Depending on the plan:
- Your share of costs for services partially covered by Part A and Part B
- Things that require out-of-pocket expenses like coinsurance, deductibles, etc.

Most other costs not covered by Medicare.

Additional Medicare resources and guides

If you are new to Medicare, you might like to start with a few of our resources, which can help you understand more, including how it works, what it covers, and what it doesn't. You will also find helpful information about the range of options available for those who are eligible for additional coverage, too.

Shop plans with Blue Cross Blue Shield of Arizona

For most people, original Medicare alone just isn’t enough coverage. That’s why Blue Cross Blue Shield of Arizona offers additional coverage options—like Part C, Part D and Medicare Supplement (Medigap)—to help protect your assets and ease your family from financial burdens associated with the cost of care. Shop additional plans online today to see what level of coverage is right for you.

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