New to Medicare? Get familiar with plans and terminology
At Excellus BlueCross BlueShield, we want to empower you to choose the best coverage for your needs. We’re taking the guesswork out of navigating Medicare by breaking down the fundamentals.
What Is Medicare?
Medicare is a federal medical insurance program in the United States. Individuals who meet certain eligibility requirements can enroll in Medicare. There are several parts to overall Medicare coverage options:
- Part A - Hospital Insurance
- Part B - Medical Insurance Coverage
- Part C - Medicare Advantage
- Part D - Prescription Drug Coverage
Most individuals enrolling in Medicare combine some or all of these parts to provide comprehensive health coverage. View Medicare options, side-by-side, in Comparing & Combining Medicare Options.
Who is eligible for Medicare?
To be eligible for Medicare, you must meet one of the following requirements:
- Age 65 or older
- Under 65 with certain disabilities
- Any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)
|Premium||A fixed amount you pay for Medicare coverage. You may pay the premium directly to Medicare, your Medicare plan such as Excellus BCBS, or both, depending on your coverage. Most premiums are charged monthly.|
|A dollar limit you must meet from the sum of your out-of-pocket payments for covered services before your plan begins to pay. For example, if your deductible is $250, you would pay that amount for a covered service and your plan would cover the rest.|
|Copayment (copay)||The fixed dollar amount you pay for a covered health care service or benefit when you receive it. For example, if your copayment is $20, you would pay that amount when you receive the health care service, and your plan would pay the remainder.|
|Coinsurance||A percentage of the cost you pay for a covered health care service or benefit when you receive it. So, if your plan has a coinsurance of 30%, your plan would cover 70% of the cost of the service.|
Financial Assistance and Support Options
You should also be aware that there are various financial assistance programs and additional support options that may be available to help bring down the types of Medicare costs detailed above.
- Extra Help: If you meet certain income limits, you may qualify for Extra Help, which helps pay for Medicare drug coverage such as plan premiums, deductibles, and prescription copays or coinsurance.
- Elderly Pharmaceutical Insurance Coverage (EPIC): A New York State program administered by the Department of Health, EPIC helps income-eligible people aged 65 and older supplement their out-of-pocket Medicare Part D drug plan costs.
- Medicare Savings Program: You may be able to get help from New York State for paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Part A and Part B deductibles, coinsurance, and copayments.
What Are The Different Parts of Medicare?
We’re breaking down the different types of Medicare, so you can better navigate enrollment.
Original Medicare - Part A & B
Original Medicare, sometimes called Traditional Medicare, is administered directly by the federal government and comes in two parts: Part A & B.
Medicare Advantage & Part D
Medicare Advantage, or Part C, is provided by a private insurer, like Excellus BCBS. Medicare Part D is prescription drug coverage.
Ready to Enroll? Our Team Is Here to Help
Excellus BCBS is here to support you and help keep Medicare enrollment simple. We’ve been working to make health coverage more accessible and affordable for everyone in our community for nearly 90 years, and our local Medicare Consultants are available to help you with all things Medicare.
Get Help From Our Team
Our dedicated local Medicare Consultants are here to answer all your Medicare questions.
Ready to enroll in Medicare? Excellus BCBS makes it easy to enroll online or over the phone.
Shop and Compare Plans
Find a Medicare plan that fits your health needs and budget.
Excellus BlueCross BlueShield is an HMO plan and PPO plan with a Medicare contract. Enrollment in Excellus BlueCross BlueShield depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. Y0028_9775_C.
This page last updated 10-01-2023.