Medicare is the federal health insurance program for people who are:
Coverage for inpatient care in hospitals or inpatient skilled care in a nursing facility as well as hospice and home health care.
Deductible: This is the amount you pay first before sharing your costs with us.
Copay: A fixed amount, like $25 you pay when you receive care or pick up a prescription.
Coinsurance: This is similar to a copay but instead of a fixed dollar amount, it is a percentage of the total bill. For example, if your child’s eyeglasses are $100 and you’ve met your deductible, your coinsurance payments of 50% would be $50. We would pay the rest, or $50.
Out-of-pocket maximum: This is the most you could ever pay in a year on covered health care services, excluding your monthly premium. Any deductible, copay, coinsurance or out-of-pocket cost for covered services goes towards your out-of-pocket maximum. If you reach this amount, all you need to do is to continue paying your monthly premium. We’ll pay 100% of the cost when you get care for covered services.
Coverage for services and supplies to treat a medical condition and preventive services to prevent or detect a medical illness in the early stages.
Medicare Advantage plans are Medicare-approved health insurance plan options offered by private health insurance companies like Excellus BlueCross BlueShield.
When you enroll in a Medicare Advantage plan, your Part A (hospital insurance) and Part B (medical insurance) will be covered under a single plan. Many of our Medicare Advantage plans include extra benefits such as prescription drugs, dental, vision, routine physicals, hearing and/or health and wellness programs. Please note that hospice services are not covered under Medicare Advantage plans, as they are paid for by Original Medicare when you enroll in a Medicare-approved hospice program.
Our Medicare Advantage Plans include:
|Preferred Provider Organization||Health Maintenance Organization||Health Maintenance Organization—Point-of-Service|
|No Primary Care Physician||Primary Care Physician||Primary Care Physician|
|In-Network & Out-of-Network Providers||In-Network Providers||In-Network & Out-of-Network Providers|
If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare.
Part D prescription drug coverage is a way to cover the cost of your prescription drugs and is available through private health insurance companies like Excellus BlueCross BlueShield. We offer Medicare prescription drug coverage through Medicare Advantage plans that include both health care and prescription drug coverage. Medicare Part D is available for eligible participants from Excellus BlueCross BlueShield.
Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Medicare Supplement plans work hand-in-hand with Original Medicare to help pay costs that Original Medicare does not, such as copayments, coinsurance and deductibles. You pay a monthly premium to a private health insurance company, like Excellus BlueCross BlueShield (in addition to your monthly Part B premium). Generally, you must have Medicare Part A and B to buy a Medicare Supplement plan.
The main differences between Medicare Advantage and Medicare Supplement plans are who covers you (whether it’s Medicare or Excellus BlueCross BlueShield) and the benefits that are covered. Both types of plans require you have Original Medicare (Parts A and B).
Often confused, these US-based health care programs are not the same. Medicare is a health insurance program which is funded by the federal government and largely serves individuals 65 and over, with some exceptions (including certain disabilities and people of all ages with end-stage renal disease). Medicaid is a joint federal and state program that helps eligible low-income individuals or families pay for the costs associated with long-term medical and custodial care. Although the majority of funding comes from the federal government, Medicaid is administered by states and program benefits may vary. Individuals who are eligible for both Medicaid and Medicare are known as Medicare dual eligibles.
The Medicare Program is divided into four sections which include Medicare Part A which covers hospital bills, Medicare Part B which covers medical insurance coverage and Medicare Part D which covers prescription drugs. Medicare Part C is Medicare-approved health insurance plan options offered by private health insurance companies, including Excellus BlueCross BlueShield, and includes combined coverage of Parts A and Part B.
|Source of Funding||Federal Government||Federal & State Governments|
|Who Is Eligible||Individuals 65 & Older with exceptions for certain disabilities and individuals with end stage renal disease of all ages||Individuals & Families of all ages whose eligibility is need-based and mainly determined by income|
|What is Covered||
Mandatory benefits include (states may provide additional benefits):
Medicaid is a program that is not only funded at the federal level, but at the state level as well, with states providing up to half of the funding for Medicaid. In some states, counties will also contribute funds. Although not required, all states have participated in the Medicaid program since 1982. Unlike Medicare, Medicaid is need-based, with eligibility determined largely by income. The primary factor in determining Medicaid eligibility is limited income and financial resources, a factor which plays no role in determining Medicare coverage.
Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States. Medicaid recipients must be U.S. citizens or legal permanent residents, and may include low-income adults, their children, and people with certain disabilities.
Medicaid also covers a wider range of health care services than Medicare. Since Congress passed Medicare into federal law in 1965 as part of the Social Security Act, coverage has been expanded to include additional benefits and increased who is eligible to receive Medicare benefits.
If you are currently working at a company with 20 or more employees, then you can wait to sign up for Medicare Part B because your employer insurance will still be the primary payer. To avoid potential penalties later on, be sure to ask your employer if the prescription drug coverage provided with your plan is creditable, meaning it covers at least as much as Medicare Part D. If you retire or lose your employer sponsored coverage, see the Special Election Period information below.
If you are currently working at a company with fewer than 20 employees and become eligible for Medicare, you should enroll in Medicare because Medicare will be your primary insurance once you become eligible. If you do not enroll in Medicare, it will be as if you do not have any coverage.
If you work beyond age 65 for an employer with less than 20 employees and you did not enroll in Part B when you turned 65, your monthly Part B premium increases 10% for each 12-month period you were eligible.
For example, if you work at a company with 13 employees and do not sign up for Part B until you are 67, your Part B premium would increase by 20%.