Whether you’re approaching retirement age or never understood how Medicare works, Blue Shield of California can help you make important decisions about health coverage that will best fit your needs.
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.
Medicare is defined in four parts: hospitalization (Part A), medical (Part B), Medicare Advantage (Part C), and prescriptions (Part D). We’ll explain each in turn.
Original Medicare coverage: Part A and Part B
Part A helps pay for inpatient hospital services and care, which are services you receive if you stay in a hospital while receiving medical care or treatment.
Part B helps pay for doctors' services, including regular visits and outpatient care (care at a hospital without staying at a hospital)
Inpatient hospital services and care
Skilled nursing facilities care
Home care services (following an acute stay)
Outpatient services, surgeries, physical, speech and occupational therapy
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, including Blue Shield, offer Medicare Advantage (MA) Plans. Only Medicare-approved private companies can offer these plans.
Medicare Advantage plans provide all the Part A and Part B benefits plus more. Some include vision, hearing, and dental coverage plus wellness programs.
Most Medicare Advantage plans include coverage for Prescription Drugs (Part D). These plans are known as Medicare Advantage Prescription Drug (MAPD) plans.
For MAPD plans, the amount you pay toward services differs depending on the plan you select. Generally, you will need to see doctors who are in the plan network.
Medicare Part D: Prescription drug plans
Some plans already include Medicare Part D coverage. If you have a Medicare Supplement plan that doesn't, a standalone Prescription Drug Plan can help. Blue Shield of California offers 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 in a Medicare Advantage – Prescription Drug plan
When am I eligible for Medicare?
You are eligible for Medicare if you fall into any of these categories:
- You are 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 Medicare coverage does Blue Shield offer?
If you're eligible for Medicare, you can get health coverage through Original Medicare alone. To help pay for additional services and benefits, you may be interested in enhancing your coverage with a Medicare Supplement plan (also known as Medigap).
You may also 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 Medicare Advantage Plans offered by Blue Shield of California, don't have any additional plan premium at all.
Blue Shield also offers standalone Medicare Prescription Drug Plans.