About Medicare

Health Plan Basics

Reviewing these key health care terms will help you choose the right Medicare plan. For detailed definitions, refer to our Glossary.

Common Terms

Deductible

The fixed amount you pay for covered services in a plan year. Most preventive care is fully covered even before you pay your deductible.

Copayment

The fixed amount you pay for covered services after you’ve paid your deductible.

Co-insurance

The percentage of costs you pay for covered services after you’ve paid your deductible.

Out-of-Pocket Maximum

The most you have to pay for covered services in a plan year. This limit doesn’t include your monthly premiums or services your plan doesn’t cover.

HMO verses PPO – What’s the difference?

HMO Health Maintenance Organization

 

You must get your health care from doctors and hospitals that are part of the plan's network. You also need to choose a primary care doctor who will manage your care and give you referrals to specialists. If you receive care outside of your plan's network, the costs won't be covered, except for emergency care.

 

PPO Preferred Provider Organization

 

You can choose to see any doctor or go to any hospital. However, a PPO plan has a preferred network of doctors and hospitals. If you get care from the plan's network, your costs are usually lower. If you choose out-of-network doctors and hospitals, they may cost more. You don't need to choose a primary care doctor or get referrals.

Important Dates

Please review this information carefully to be sure you understand important enrollment and disenrollment deadlines. Also, please be aware before signing up for a Blue Cross Medicare plan, you must be eligible for Medicare Part A and enrolled in Medicare Part B.

Medicare Advantage Plans & Medicare Part D Prescription Drug Plans (PDP)

If you're newly eligible for Medicare.

You can apply for a Medicare Advantage or Part D plan during any of the seven months that make up what's called the Initial Enrollment Period. This includes the three months before your birth month, the month of your birthday, and the three months after your birth month.

If you get Medicare due to a disability.

You can apply for a Part D plan during the 7-month period that begins 3 months before your 25th month of disability and ends 3 months after your 25th month of disability. You can also enroll during any of the seven months that includes the three months before your 65th birthday, the month of your 65th birthday, and the three months after your 65th birthday.

Open Enrollment from October 15 to December 7 each year.

During this time, you may enroll in a Medicare Advantage or Medicare Part D plan for the first time, change prescription drug plans, change Medicare Advantage plans, or return to Original Medicare. Your plan selection will take effect on January 1 of the following year.

Medicare Advantage Disenrollment Period from January 1 to February 14 each year.

If you're a Medicare Advantage member, you can leave your plan during this time and switch to Original Medicare. If you switch to Original Medicare, you'll have until February 14 to join a Medicare Part D Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan receives your enrollment form.

Enrolling throughout the year due to special circumstances.

If you have special circumstances, you can make changes to your Medicare Advantage or Part D Prescription Drug Coverage throughout the year, without worrying about the time periods listed above. Examples of a special circumstance would be if you move out of your current plan's service area or if you retire past the age of 65.

Medicare Supplement Plans (Medex)

Enroll at any time during the year.

After you enroll, you have, by law, at least 30 days to review your plan. If you decide you don't want the plan, you can get a full refund of any premiums you've paid during this "free look" period.