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    • Intro to Medicare
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      • Eligibility and Enrollment
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      • Medicare Advantage
      • Prescription Drug Coverage
      • Plan that’s Right for you
      • Sign-Up for a Guide Book and Email
      • Medicare Basics Video Series
    • Are You Eligible For Medicare?
    • Are Your Drugs Covered?
    • Attend a Seminar
    • About Medicare
      • Health Plan Basics
      • Important Dates
    • Request a Call
  • Health & Wellness
    • Finding Care
      • 24-Hour Nurse Line
      • Care Management
      • ER Alternatives
      • Find a Doctor
      • Member Support & Assistance Program
        • In-home Care from Landmark Health
        • In-home Health Assessments with Signify Health®´
        • Personalized Support for Disease Management
        • Quality Optimizer
        • Additional Programs
      • Mental Health
      • Supporting Caregivers
    • Manage Your Health
      • Managing Diabetes
      • Preventive Care
      • Flu Prevention
      • Chronic Care
      • Fall Prevention
      • Urinary Incontinence
      • Meals and Nutrition
  • Member Resources
    • Plan Information
      • Plan Documents
      • Quality Assurance
      • National Coverage Determination
      • Ending Membership
    • Pharmacy Benefits
      • Drug Benefits
        • Home Delivery
        • Formulary Overview
        • Coverage Requirements
        • Formulary Changes
      • Medicare Advantage Pharmacy Network
      • Plan Drug Transition Policy
      • Medication Therapy Management
      • Prescription Drug Utilization Review
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Intro to Medicare

Your Coverage Choices

Types of Plans

There are several types of Medicare plans. It's up to you to decide which services you choose and who administers your benefits (a private health insurance company or the government).

Original Medicare

Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) are often referred to as Original Medicare. If you have Original Medicare, you will receive your benefits through the federal government.

Medicare Advantage Plans

Private insurance companies like Blue Cross Blue Shield of Massachusetts offer Medicare Advantage Plans. By law, insurance providers must offer the same benefits as Original Medicare and can also offer you additional benefits as well. HMOs and PPOs are examples of these private health plans. Some plan options even include Medicare Prescription Drug Coverage (Part D) benefits.

Medigap Policy (Medicare Supplement Insurance)

A Medigap policy is health insurance offered by private insurance companies to fill uncovered costs or "gaps" that Original Medicare doesn't cover.

Part D Prescription Drug Plans

This coverage option can help lower your current prescription drug costs and keep you from having to pay higher costs in the future. These plans are only available through private insurance companies, like us.

How Does Medicare Work With Other Insurance?

If you have Medicare and other health insurance (or coverage), each type of coverage is called a "payer." When there's more than one payer, the "coordination of benefits" rule decides which one pays first. The "primary payer" pays what it owes first and then sends the remainder of what is owed to the "second payer" to pay. In some cases, there may also be a third payer.

Whether Medicare pays first depends on a number of situations.

For example, if you are 65 or older, entitled to Medicare, and you are covered by a group health plan because you or your spouse is still working, the chart below demonstrates when Medicare would pay first.

If you have questions about who pays first, or if you have questions about who pays first, or if your coverage changes, call the benefits coordination & Recovery Center(BCRC) toll-free at  1-855-798-2627. (TTY: 1-855 797 2627)

Number of Employees  Pay First Pay Second
If the employer has 20 or more employees Group Health Plan Medicare
If the employer has less than 20 employees Medicare Group Health Plan

*  If your employer participates in a plan that's sponsored by two or more employers, the rules are slightly different.

How do primary and secondary coverage work together?

The insurance that pays first (primary payer) pays up to the limits of its coverage. Then the secondary payer only pays if there are costs that were not covered by the primary insurer. Keep in mind, the secondary payer (which may be Medicare) may not pay all of the uncovered costs.

If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.

What does "paying first" mean?

When an insurer pays first, it means they have paid the bill up to the limits of the coverage. It doesn't mean the primary payer necessarily paid before the secondary payer. In fact, if the primary payer doesn't pay the claim promptly (usually within 120 days), your doctor or other insurance provider may bill Medicare.

Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should have made. A conditional payment is a payment Medicare makes for services another payer may be responsible for.

Two Options to Getting Your Medicare Coverage

When it comes to health care coverage, you have options. The key is to explore them thoroughly and make the choice that best fits your lifestyle and health needs.

Option 1: Original Medicare + Medigap (Medicare Supplement) + Part D

Original Medicare + Medigap (Medicare Supplement) + Part D

Part A (Hospital Insurance): No premium for most people


Part B (Medical Insurance): Optional at a standard monthly premium

You can also add to Original Medicare with:

Medigap Policy (Medicare Supplement Insurance)


An optional policy, purchased from private insurance companies to fill in gaps in Original Medicare coverage.

Part D Prescription Drug Coverage


An optional policy, purchased from private insurance companies, which covers costs for prescription drugs. Part D plans are often paired with a Medigap plan for comprehensive coverage across all aspects of your health care.

Option 2: Original Medicare + Part D + More = Medicare Advantage

Original Medicare + Part D + More = Medicare Advantage
  • Provide Medicare Parts A and B benefits (you must enroll in Parts A and B); possible additional benefits like vision, hearing, and dental.
  • Available for purchase from private insurance companies
  • Out-of-pocket costs vary by plan types and insurance companies
  • Medicare Advantage plans include
    • HMO
    • PPO
    • PFFS
    • Some plans include Part D prescription drug coverage
  • Your monthly premium equals your Part B premium and Medicare Advantage plan premium

For more information, visit www.medicare.gov and download the Medicare & You brochure, or call 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048), 24 hours a day/7 days a week, for details.

Blue Cross Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities that have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.

You can file a complaint if you feel that you received inaccurate, misleading or inappropriate information. Please call Member Service at 1-800-200-4255 (TTY users call: 711). If your complaint involves a broker or agent, be sure to include the name of the broker/agent when filing your complaint.

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Last Updated: 01/01/2023

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