Blue Shield Group Medicare

Stay well ahead with plan options that fit your needs

What is Medicare?

Medicare is a federal health insurance program provided by the U.S. federal government for people 65 or older. Medicare also covers some younger people with certain disabilities and people with End-Stage Renal Disease (ESRD). Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage Plan), and Part D (prescription drug coverage).

Medicare Part A: hospitalization insurance

Covers services received in a hospital or long-term care setting:

  • Inpatient hospital services and care
  • Skilled nursing facilities care
  • Hospice care
  • Home care services (following an acute stay)
  • Transplants

Medicare Part B: medical insurance

Covers outpatient care, doctor services, medical supplies, and preventive services:

  • Doctor’s visits
  • Outpatient services, surgeries, physical, speech and occupational therapy
  • Ambulance services
  • Home care services (not following acute stay)
  • Medical and lab tests
  • Durable medical equipment and supplies
  • Preventive care, mammography, Pap tests

Medicare Part C: Medicare Advantage plan

Medicare Advantage plans include everything covered by Medicare Part A and Part B. Often with extra benefits such as vision, hearing, dental, and wellness programs. Most plans include coverage for prescription drugs (Part D). These are known as Group Medicare Advantage Prescription Drug (GMAPD) Plans. Only Medicare-approved private companies can offer these plans and typically costs extra.

Medicare Part D: Prescription drug coverage

Provides standalone coverage for your prescriptions and if offered through private health plans you can choose this standalone coverage. This works well with a Medicare Supplement plan or combine it with a Group Medicare Advantage Prescription Drug (GMAPD) Plan. Either choice helps you cover the costs of your prescription drugs.

Eligibility You become eligible for Medicare coverage when you turn 65. Younger people with a disability or End-Stage Renal Disease may also be eligible. For those younger than 65 with questions about eligibility, please visit Medicare.gov.

The Medicare eligibility rules are the same for everyone. But the enrollment period may be different. Your window of seven months to sign up begins three months before the month you turn 65. It ends three months after the month you turn 65.

When you are ready to retire or if you plan on working past your Medicare entitlement, please reach out to your Plan Sponsor to find out what Mediare products you will need to enroll in.

Blue Shield of California Group Medicare plan types

Contact your plan sponsor for more information on which plan types they offer. Your plan sponsor is the organization that manages your health plan benefits.

Group Medicare Advantage Prescription Drug Plan HMO

An all-in-one GMAPD-HMO alternative to Original Medicare. These bundled options include the full benefits of Medicare Parts A and B in a single plan and include prescription drug coverage. With these plans, in-network providers include Blue Shield’s Medicare, HMO contracted providers.

Group Medicare Advantage Prescription Drug Plan PPO

An all-in-one GMAPD-PPO alternative to Original Medicare. These bundled options include the full benefits of Medicare Parts A and B in a single plan and include prescription drug coverage. With these plans members can access out-of-network providers or any Medicare Participating provider if they are willing to bill Blue Shield directly, or the local Blues plan if the member is out of state.

Group Medicare Advantage Only Plan

An all-in-one GMA only alternative to Original Medicare. These bundled options include the full benefits of Medicare Parts A and B in a single plan. With these plans members can access out-of-network providers or utilize any Medicare Participating provider if they are willing to bill Blue Shield directly, or the local Blues plan if the member is out of state.

Group Prescription Drug Plan

Blue Shield Group Medicare Prescription drug plans provide a variety of coverage options for your prescription drug costs. These plans offer affordable copays and access to network retail pharmacies.

Medicare FAQs

When am I eligible for Medicare?
You become eligible for Medicare when you turn 65. You have a window to sign up for Medicare. It begins 3 months before you turn 65 and ends 3 months after you turn 65. Younger individuals who have a disability or End-Stage Renal Disease may also be eligible.
How do I know if I am covered by my employer after 65?
The first step in deciding whether you should explore Medicare enrollment while working beyond the age of 65 is to make sure that you are covered by work after 65. It’s important to make sure you have a conversation with your plan sponsor before your 65th birthday to make sure you know what you need to do in terms of health insurance coverage.
Will I get Part A if I don't retire at 65?
If you have been working for at least 10 years, and paying your Medicare taxes, Medicare Part A is available for free. If you qualify for premium-free Part A, you can always just opt for Part A of Medicare, even before retirement regardless of whether you have health coverage from your plan sponsor. It’s important to make sure that you decline Part B coverage and ensure that your current employment status is recorded as the reason why you are opting out of Part B coverage.
What do I do when I am ready to retire after I am 65?
When you are ready to leave work life behind, there is important information to keep in mind about Medicare and retirement. There is a special enrollment period to keep in mind when retiring, regardless of the kind of coverage you have. This special enrollment period allows you to apply for Medicare for eight months—starting the month after the month you retire or the month after the day you lose your plan sponsored health insurance.
Which Blue Shield of California Medicare plan(s) does my employer offer?
Speak with your plan sponsor to learn more about your Group Medicare plan options and how to enroll.
What are the Blue Shield of California Retiree eligibility requirements?
To enroll in a Blue Shield of California Retiree plan, you must meet the eligibility requirements. You must have both Medicare Parts A & B, live in a Blue Shield assigned service area, be a U.S. citizen or lawfully present in the U.S., and meet your plan sponsors eligibility requirements.
Are your doctors, specialists, or hospitals part of a network?
Popular Medicare Advantage Plans such as Health Maintenance Organizations (HMO) restrict your usage of medical facilities to a fixed network. Ask your doctor if they are part of the network of plans you are considering, or if they can refer you to someone within that network. Preferred Provider Organizations (PPO) plans allow you to use any provider that accepts Medicare and will bill your Medicare Advantage Plan. To find out if your providers are in the Blue Shield network for the plans being offered to you, visit, our Find a Doctor tool.
Is your pharmacy In-Network?
Blue Shield has a large network of pharmacies. To find out if your pharmacy is In-Network visit here.
Are my prescription drugs covered?
Blue Shield formulary listing can be found here.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Blue Shield of California is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal.

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Page Last Updated 5/27/2026