What is Medicare?

Medicare is a federal health insurance program that offers coverage for:

  • People age 65 and older
  • Certain disabled people under age 65
  • Anyone with kidney failure

The program is managed by the Centers for Medicare & Medicaid Services.

 

Original Medicare coverage: Part A and Part B

Part A helps pay for hospital services if you're an inpatient. It also pays for care in a skilled nursing facility or hospice, and some home health care. 

Part B helps pay for doctors' services when you're an inpatient at a hospital. It also covers:

  • Outpatient care
  • Medical tests
  • Ambulance transport
  • Medical devices 

Part B also pays for routine care, including mammography and Pap tests.

Part A (hospital services)
Part B (medical services)

Inpatient hospital services and care

Skilled nursing facilities care

Hospice care

Home care services (following an acute stay)

Transplants

Doctor visits

Outpatient services, surgeries, physical, speech and occupational therapy

Ambulance services

Home care services (not following an acute stay)

Medical and lab tests

Durable medical equipment and supplies

Preventive care, mammography, Pap tests

 

Medicare Part C: Medicare Advantage Plans

Companies such as Blue Shield offer Medicare Advantage (MA) Plans. Only Medicare-approved private companies can offer these plans.

  • Medicare Advantage Plans provide all of the Part A and Part B benefits plus more. Some include vision, hearing and dental coverage, plus wellness programs. Most plans include coverage for prescription drugs (part D).
  • The amount of money you pay toward some services may differ when you have a Medicare Advantage Plan. And, generally you will need to see doctors who belong to the plan.

 

Medicare Part D: Prescription Drug Plans

Some plans already have a Medicare part D coverage included. If you have a plan that doesn't, like a Medicare Supplement plan, a Prescription Drug Plan can help. Private companies, including Blue Shield, offer these plans to help you cover the costs of your prescription drugs.

You can choose:

  • Standalone prescription coverage (Prescription Drug Plan), which works well with a Medicare Supplement plan
  • Medical and prescription coverage combined (like a Medicare Advantage Prescription Drug Plan)

 

Who can get Medicare?

You are eligible for Medicare, if you fall into any of these categories:

  • You are age 65 or older and eligible for Social Security or Railroad Retirement benefits.
  • You are 65 or older and married to someone eligible for Social Security or Railroad Retirement benefits.
  • You've been receiving Social Security disability benefits for at least 24 months.
  • You have End-Stage Renal Disease (kidney failure).

 

What does Blue Shield have to do with Medicare?

If you're eligible for Medicare, you can get health coverage through Original Medicare alone. However, many people find that Original Medicare does not cover all their healthcare needs because many medical services and supplies are not covered. To help pay for these services and supplies many people enhance their coverage with a Medicare Supplement Plan (also known as Medigap).

Others like the convenience and coverage of a Medicare Advantage plan that provides rich benefits without large plan premiums. In fact, some of these plans, like most of the plans offered by Blue Shield of California, don't have any additional plan premium at all.

Blue Shield also offers stand-alone Medicare Prescription Drug Plans.

 

Medicare options infographic

 

Learn more about these Blue Shield Medicare plan options.