Medicare Q&A Videos
Are all Medicare plans with different insurance carriers the same?
What is the Blue Cross Medicare Blue-To-Blue feature?
I keep hearing about Medicare plans for no cost. How is this possible? Is it true?
Are you receiving a lot of calls about Medicare and already have Medicare or a Medicare Supplement?
Medicare Plans
What Is Original Medicare?
Original Medicare is comprised of Part A (hospital benefits) and Part B (medical benefits).
It is administered by the federal government.
What Is Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is provided by private insurance companies, like Blue Cross NC.
It covers the same types of care as Medicare Parts A and B but lowers your share of the costs when you use doctors and hospitals that are part of the plan’s network.
In addition, most Medicare Advantage plans offer prescription drug coverage and supplemental benefits such as gym memberships, vision coverage, dental coverage, and more.
What is Medicare Supplement?
Medicare Supplement Insurance, sometimes called Medigap, are policies offered by private insurers – standardized by the federal government.
These plans help fill gaps in Original Medicare and may cover some or all of the costs not covered by Original Medicare such as copayments, coinsurance, and deductibles.
What is Medicare RX?
Medicare RX, better known as Medicare Part D, is prescription drug coverage for those enrolled in Original Medicare (Parts A & B).
Plans are available from private insurers, like Blue Cross NC.
If you are enrolled in a Medicare Advantage plan, you are not eligible for this standalone prescription drug coverage.
If you are interested in a Medicare Advantage plan and need drug coverage, be sure to choose a Medicare Advantage plan that includes drug coverage.
Medicare Coverage
Does Medicare cover preventative care?
Original Medicare covers many preventive services, such as flu shots and pneumonia shots.
Does Medicare cover pre-existing conditions
Both Original Medicare and Medicare Advantage cover pre-existing conditions. Medicare Supplement plans may be subject to a waiting period.
Does Medicare cover flu shots
Yes. Medicare covers one flu shot per year.
If you are seeing your doctor for more than a flu shot, you may still be charged a copay for that visit if applicable to your plan.
Does Medicare cover pneumonia vaccines?
Yes. Medicare Part B covers two different pneumococcal shots.
The first shot can be administered at any time; the second must be given at least one year after the first shot in order to be covered.
Does Medicare cover the shingles vaccine?
No. Medicare Part B does not cover the shingles vaccine.
However, Medicare Part D does.
Does Medicare cover dental, hearing, and vision coverage?
Medicare Advantage plans may or may not include dental, hearing and vision benefits and/or allowances.
Original Medicare and some Medicare Supplement plans do not cover dental, hearing and vision services that are not medically necessary, but you can purchase dental or vision plans separately.
Does Medicare cover long-term care?
Expenses for long-term care facilities, such as nursing homes, are not covered.
However, Medicare does include benefits for a skilled nursing facility for rehabilitation and medical treatment (from a surgery or other significant inpatient medical procedure).
Does Medicare cover me while I'm traveling?
With Original Medicare and Medicare Supplement, you can see any doctor or visit any hospital that accepts Medicare.
Some plans also offer coverage for foreign travel and foreign emergency care. With Medicare Advantage PPO plans, you may use your out-of-network benefits when traveling outside the service area. Medicare Advantage HMO plans provide coverage in the event of an emergency.
Does Medicare cover perscription drugs?
Some medications may be covered under Original Medicare’s Part B benefits.
For more robust coverage, you may purchase a Medicare Rx (Part D) plan to add to Original Medicare, or purchase a Medicare Advantage plan that includes prescription coverage.
Does Medicare use a provider network?
Original Medicare and Medicare Supplement provide coverage at any Medicare-participating doctor or hospital coast-to-coast.
Medicare Advantage plans are coordinated care plans, which means they are built around a network of doctors and hospitals working together to provide your care.
Can I lose my Medicare coverage?
To maintain your Medicare coverage, you must stay current on your monthly premiums.
Medicare Enrollment
How can I determine if I'm elligible for Medicare?
The simplest way would be to check your eligibility status on: Medicare.gov
How do I enroll myself into Medicare?
You can begin your Medicare enrollment at: https://www.ssa.gov/benefits/medicare/
If you’d like to purchase a Medicare Advantage plan, Medicare Supplement plan or Medicare Prescription Drug plan (PDP), you need to enroll in Parts A and B before purchasing those plans.
Am I automatically enrolled into Medicare when I turn 65?
In most cases, it depends on whether you’re getting Social Security benefits.
Some people get Medicare Part A and Medicare Part B automatically, while others have to sign up manually.
You can learn more at Medicare.gov.
Is Medicare free?
Medicare Part A is usually available at no cost if you or your spouse made payroll contributions to Social Security for at least 10 years.
Medicare Part B comes with a monthly premium based on your income. Some Medicare Advantage (Part C) plans, Medicare Supplement and Medicare Rx (Part D) also come with a monthly premium.
What if I'm not retiring at 65?
You still qualify for Medicare at age 65, but it may or may not make sense to enroll.
Check with your employer’s human resources manager, benefits specialist, or a Blue Cross NC agent to learn about your options.
In some cases, if you keep your current coverage and wait until later to join Medicare, you may have fewer choices and/or pay more.
What happens to my Medicare benefits if I go back to work after retiring?
You can discontinue your Medicare coverage to enroll under an employer plan.
When you’re ready for Medicare again, you’ll still be eligible under a Special Enrollment Period.
What if I have retiree benefits that include health insurance?
Check with your human resources manager or benefits specialist to see your options.
In some cases, if you keep your current coverage and wait until later to join Medicare, you may have fewer choices and/or pay more.
What is a late enrollment penalty?
If you enroll in Parts A, B or D after 3 months from your eligibility date, you may have to pay a higher premium for Parts B and D.
This penalty is required by the federal government. For more information about late enrollment, visit Medicare.gov.
Must I continue to pay my Part B premium if I enroll in Medicare Advantage (Part C), a Medicare Perscription Drug Plan (PDP), or a Medicare Supplement plan?
Yes.
You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
Can I qualify for financial assistance if I have limited income?
If you have Medicare and Medicaid, you already qualify for low income assistance.
If you don’t qualify for Medicaid, you may still qualify for some assistance. The amount of assistance will depend on your income and resources and will be applied to the cost of the Medicare prescription drug coverage portion of your Blue Medicare HMO or PPO plan.
Learn more about financial assistance: https://medicare.bluecrossnc.com/medicare/help-premiums
What if I want to change plans?
There are two opportunities for everyone to switch plans:
- The Annual Enrollment Period (AEP)
- October 15 to December 7
- The Open Enrollment Period (OEP)
- January 1 to March 31.
For example, if you enroll or switch plans in the fall but decide you don’t like the plan once your coverage begins in January, you can switch back to Original Medicare or another Medicare Advantage plan before March 31.
You can also change plans anytime you qualify for a Special Enrollment Period. Visit Medicare.gov for more information about Special Enrollment Periods.
Medicare Advantage
What is the difference between original Medicare and Medicare Advantage
Original Medicare is Medicare Parts A and B. It is administered by the federal government.
Medicare Advantage (Part C) is provided by private insurance companies, like Blue Cross NC. It covers the same types of care as Medicare Parts A and B but lowers your share of the costs when you use doctors and hospitals that are part of the plan’s network.
Do I need to enroll in Original Medicare to be eligible for a Medicare Advantage plan?
Yes.
You’ll need to be enrolled in Original Medicare (Parts A and B) to be eligible for a Medicare Advantage plan.
What happens to my Medicare coverage when I join a Medicare Advantage plan?
Once you become a Blue Medicare HMO or Blue Medicare PPO member, you transfer the administration of your Medicare benefits to the plan.
This means you maintain your status as a Medicare beneficiary, plus gain the enhanced coverage available through your health plan. You will receive a member ID card that you will present when using your benefits. You should present this card when using your pharmacy benefits as well. You are still responsible for paying your Medicare Part B premium.
Can I join a Medicare Advantage plan without losing my military benefits?
Yes.
If you join Blue Medicare HMO or Blue Medicare PPO, you can keep your military benefits.
Can I enroll in Medicare Advantage if I have End-Stage Renal Disease?
Yes.
As of 2021, people with End-Stage Renal Disease can enroll in Medicare Advantage.
How do I see if my doctor or pharmacy is in-network before enrolling in the Blue Medicare Advantage plan?
You can search for doctors in the Blue Cross NC network using their Find a Doctor tool.
You can also use the tool to search for in-network pharmacies and medical facilities.
What is a Welcome To Medicare exam vs an annual physical?
As a Medicare Advantage member, you are entitled to receive a one-time Welcome To Medicare exam within the first 12 months of enrollment in Medicare Part B.
The Welcome to Medicare exam offers an opportunity for your doctor to review your medical and personal history, conduct several simple measurements and screenings related to your well-being, and outline a plan for future preventive services.
One annual routine physical exam is covered at no cost to you. This includes baseline measurements such as blood pressure, height and weight, review of risk factors, and certain diagnostic tests that include complete blood count and urinalysis. Use of your primary care physician (PCP) on record is highly encouraged.
If you have been enrolled in Medicare Part B for more than 12 months, you will want to schedule this as an Annual Wellness Visit. It’s important to schedule the correct visit so it can be covered correctly.
Am I covered in an emergency with Medicare Advantage?
Blue Medicare HMO and Blue Medicare PPO plans cover eligible emergency services for you in or out of the service area.
If you have a medical emergency, go to the nearest medical facility or call 911. Emergency services require a copayment, but it will be waived if you are admitted to the hospital on an inpatient basis within 48 hours. Please contact your primary care physician (PCP) or Blue Medicare HMO or Blue Medicare PPO within 48 hours so your PCP can coordinate follow-up care.
What happens if I join a Medicare Advantage plan and my doctor leaves the network?
If you have a PPO plan, you can use your out-of-network benefits for your doctor and may pay more.
Otherwise, your plan will notify you if your doctor leaves the plan network, and you’ll be able to choose a new doctor.
Can I keep my Blue Medicare Advantage plan if I move outside of North Carolina?
If you permanently move out of state, you’ll need to sign up for a Medicare Advantage plan in that state, or switch to Original Medicare.
Medicare RX
Do I need a Medicare RX (Part D) plan if I have a Part B plan?
Medicare Part B covers a limited number of outpatient prescription drugs under limited conditions.
Drugs covered under Part B are drugs you’d have administered in a doctor’s office or hospital outpatient setting, such as a flu vaccine. You can view a list of these drugs at Medicare.gov.
For medications you’d administer yourself, including maintenance medications and drugs prescribed by a doctor to take at home, you’d want to consider a Medicare Rx (Part D) plan or a Medicare Advantage plan that includes prescription drug coverage.
Do I need to enroll in Original Medicare to be eligible for a Medicare RX (Part D) plan?
You’ll need to be enrolled in either Part A or Part B of Original Medicare to be eligible for a Medicare Rx (Part D) plan.
If you’re enrolled in Medicare Advantage without prescription coverage, you cannot enroll in a standalone Medicare Rx plan. If you’d like a Medicare Advantage plan plus drug coverage, be sure to choose a Medicare Advantage plan that includes drug coverage.
How does Medicare perscription drug coverage work?
Medicare has designed a “standard benefit.”
Companies may offer additional enhanced plans, but they must offer a standard benefit package that is at least equal in value to Medicare’s standard benefit as follows:
$435 deductible – You will be responsible for 100% of the first $435 in total prescription drug costs in each calendar year before your prescription drug benefit begins.
25% coinsurance – After the first $435, you will be responsible for 25% of the total cost of your prescription drugs. The Plan will pay 75% of your total drug costs until they reached a total of $4,020.
100% coinsurance – After your total drug costs reach $4,020, you will be responsible for all of your prescription drug costs until you reach an annual out-of-pocket limit of $6,550. This is referred to as the “coverage gap.”
5% coinsurance – After your total out-of-pocket costs reach $6,550, you will pay very little for prescription drugs. You will pay only 5% (or $3.70 generic/$9.20 brand name>, whichever is greater) for prescription drugs and your insurance company will pay the rest.
What drugs are covered under Medicare prescription drug coverage?
Each plan provider will establish its own formulary, or list of prescription drugs, that it will cover. Although formularies must meet certain requirements set by Medicare, they still differ by plan.
Generally speaking, Medicare prescription drug coverage covers drugs that meet the following criteria:
- They must be available only by prescription
- They must be approved by the Food and Drug Administration
- They must be used and sold in the United States
- They must be used for a medically necessary indication
Specifically, coverage will include:
- Prescription drugs
- Vaccines
- Insulin
- Certain medical supplies associated with the injection of insulin (syringes, needles, alcohol swabs and gauze).
Certain drugs, or classes of drugs, will not be covered because they are excluded by law, such as over the counter medicines like aspirin.
To learn which drugs are covered by Blue Cross NC Blue Medicare Rx (PDP) plans, search our formulary: https://www.myprime.com/en/medicines.html#find-medicine
How will I know if my medications are on the Blue Cross NC formulary?
- You can search for specific drugs online: https://www.myprime.com/en/medicines.html#find-medicine.
- If you’re not a Blue Cross NC member, contact Sales at 1-800-665-8037.
- Current Blue Cross NC members can call Customer Service at 1-888-247-4142 (TTY: 711). We are available for phone calls 8 a.m. to 8 p.m. daily.
Are mail-order drugs available through Blue Medicare RX?
You have the convenience of ordering your prescriptions from the mail order pharmacy, AllianceRx Walgreens Prime: https://www.alliancerxwp.com/
You can purchase up to a 90-day supply through mail order, and your medications will be delivered directly to your home. Depending on your plan, there may be savings available to you if you use the mail option.
Can I use my Medicare RX plan to order drugs from Canada?
No.
Only drugs purchased in the United States are eligible for Medicare prescription drug coverage.
Can I use my Medicare RX plan if I need to fill a prescription while traveling out of state or outside the country?
If your in-network pharmacy is part of a large national chain, your prescription may be covered under the in-network rate.
Otherwise, you would use your out-of-network pharmacy benefits to fill a prescription out-of-state. International pharmacies are not eligible for Medicare prescription drug coverage.
Can I keep my Medicare RX plan if I move outside of North Carolina?
No.
Medicare Rx plans are based on the plan’s formulary and pharmacy network, you’d need to enroll in a Medicare Rx plan in your new state.
Can I change my Medicare RX plan?
Congress designed Medicare prescription drug coverage on an annual enrollment cycle.
This means that each year, you will have the option to re-enroll in your existing Medicare prescription drug coverage plan or change plans between October 15 and December 7 each year.
If you qualify for a Special Enrollment Period (SEP), you can change your Medicare Rx plan.
You may also have another opportunity during the year to switch plans, under limited circumstances. For example, if you move out of your plan’s service area, you’ll have an opportunity to choose another plan that serves your new area.
Medicare Supplement
To what plans can I add Medicare Supplement?
What does a Medicare Supplement plan cover?
Supplement plans help cover costs not covered by Original Medicare, such as coinsurance, copays and deductibles.
Compare Medicare Supplement plans: Visit BlueCross
Do I have to use an in-network doctor with Blue Medicare Supplement?
Blue Medicare Supplement benefits can be used coast-to-coast with any provider or facility that accepts Medicare.
Can I keep my Medicare Supplement plan if I move outside of North Carolina?
If your Medicare Supplement plan is from Blue Cross NC you can keep your plan if you move to a different state.
Still Have Questions?
There’s a lot when it comes to Medicare, but we’re here to help.
If you have a question not listed above, please reach out to our team and we’d be happy to provide an answer.
