Medicare FAQ
Are you looking for a trusted guide to help you navigate Medicare? Blue Cross Blue Shield of Massachusetts is here for you with easy-to-understand answers. Start by reading some of the most frequently asked questions (FAQ) about Medicare below.
When Am I Eligible to Enroll in Medicare?
You may enroll in a Medicare plan during the Initial Enrollment Period (IEP) which is the seven months surrounding your 65th birthday, which includes:
- Three months before your 65th birthday
- During your birthday month
- Three months after your 65th birthday month
An Initial Enrollment Period and Coverage
The time at which your Medicare coverage begins depends on when you sign up during IEP.
| Three Months before your 65th birthday month. | Your birthday month. | Three Months after your 65th birthday month. |
|---|---|---|
| Coverage will start the first day of your birthday month. | Coverage will start the first day of the following month. | Coverage will start the first day of the month after you enrolled. |
What Are the Benefits of Signing Up for Medicare at 65?
Signing up for Part B during the Initial Enrollment Period means you won’t have to wait for the General Enrollment Period or a Special Enrollment Period (if you qualify). It also means you won’t have to worry about paying a Late Enrollment Penalty.
What Is the Part B Late Enrollment Penalty?
Your monthly premium will permanently increase 10% for each 12-month period you could have enrolled but didn’t. This would mean you decided not to sign up during your Initial Enrollment Period or a Special Enrollment Period.
Do I Have to Enroll If I’m Still Working?
If you’re covered by a group health plan under your own or through your spouse's current employer, you may be able to delay signing up for Part B during your Initial Enrollment Period and enroll later during a Special Enrollment Period. Call Social Security or your company’s benefits administrator to find out the best time to enroll in Part B.
You may sign up for Part B at any time while a group health plan covers you:
- Based on your own or your spouse's current employment
- During the eight months following the last month of employment
- Or coverage by the health plan, whichever occurs first
People who sign up for Part B during the Special Enrollment Period usually don't pay a penalty.
You may want to enroll in premium-free Part A when you turn 65, but wait to sign up for Part B (since you will have to start paying premiums).
Does Full Retirement Age Affect How I Pay My Part B Premium?
If you get Social Security benefits, Social Security takes the Part B premium out of your monthly payment. If you don't get full Social Security benefits yet, Medicare will bill for your Part B premium every three months. If you don't get your bill by the 10th of the month, call Social Security anytime, 24 hours a day, at 1-800-772-1213. TTY users should call, 1-800-325-0778.
How Do I Sign Up for Medicare?
If you’re already receiving Social Security benefits, you will be automatically enrolled in Original Medicare (Parts A and B), which covers hospitals, doctors, in-home care and more. Learn more about what each part of Medicare covers.
To enroll in a Medicare Advantage (Part C), Medicare Supplement or Medicare Prescription Drug (Part D) plan, you must contact the health insurance provider directly. You may enroll three months before, the month of or three months after your 65th birthday (Initial Enrollment Period).
What if I Want to Switch My Medicare Coverage?
You can! You must wait until the Medicare Annual Enrollment Period from October 15 to December 7. Special circumstances allow you to switch outside of the Medicare Annual Enrollment Period, such as moving, leaving a job or going into a long-term care facility.
What Is the Medicare Coverage Gap?
In 2024, Prescription Drug Plans (Part D) have two different maximums. A maximum amount that they’ll pay for prescription coverage and a maximum that you’ll pay out of pocket. So, there’s a gap (or coverage gap) between you being over your benefits limit but below the maximum out-of-pocket you can spend.
Don’t worry, you’re still protected.
Once you reach the end of your benefits coverage, you’ll pay no more than 25% of the total cost of your prescription drug. If a drug costs $100, you’ll only pay $25 out of pocket. Even better, the total cost of the drug counts towards your yearly maximum, so while you only pay $25, it’ll count as $100 towards your yearly maximum out-of-pocket limit. Your drugs will be covered 100% once you hit your yearly limit.
Effective 1/1/2025, due to the Inflation Reduction Act, you are no longer subject to the Coverage Gap phase. You will pay your normal cost-sharing until you reach your Maximum Out-of-Pocket in calendar year 2025.
Can I Have a Supplemental Plan and a Medicare Advantage Plan?
No, a supplemental plan only covers expenses not covered by Original Medicare. Since a Medicare Advantage plan offers different coverage, there’s no need for a Medicare Supplement plan. Learn more about the differences between Medicare Supplement and Medicare Advantage plans.
Does Original Medicare Cover Dental Care?
Original Medicare does not cover dental costs.
When Can I Enroll in Dental Insurance?
Standalone dental insurance like our Blue Cross Dental Blue 65 plans can be purchased year-round. Many Medicare Advantage Plans offer supplemental benefits including dental. You can enroll in a Medicare Advantage plan during specific enrollment periods.
What Is the Difference Between Copay and Co-insurance?
A copay is a fixed amount that you pay for a health care service. If your plan has a $50 copay for urgent care, you’ll pay $50 when you go to an urgent care facility.
A co-insurance is a percentage of the total service cost you’ll need to cover. For example, if you have a 20% co-insurance on hospital stays, and your stay costs $1,000, you’ll need to pay $200.
Do I Need a Primary Care Physician (PCP)?
With Original Medicare, you can visit any doctor, hospital, or specialist that accepts Medicare, so you don't need to have a Primary Care Physician (PCP) — although we do recommend you have one.
With a Medicare Advantage Plan, you need a PCP with an HMO plan to coordinate your care and send referrals for specialists. However, with a PPO plan, you don’t need referrals, but your provider of choice acts like a PCP to help coordinate your care.
What Is an Authorization?
Sometimes a health plan may require a doctor to submit proof that a health service is medically necessary. Authorization can also be called prior authorization or precertification.
Do I Need To Keep My Red, White and Blue Medicare Card?
You should. It’s an important document and you'll need it if you decide to switch plans or return to Original Medicare. However, if you have a Medicare Advantage plan, you’ll present your plan membership card when it’s time for care.
Do I Need a Separate Prescription Drug Plan for My Medicare Advantage Plan?
Not usually, because many Medicare Advantage plans include prescription drug coverage.
What’s the Difference Between a Preferred or Standard Pharmacy?
Preferred pharmacies offer a lower co-pay on covered prescription drugs compared to standard pharmacies.
What’s the Difference Between a Medicare Supplement Plan and Medigap?
Medicare Supplement plans and Medigap are the same thing. Medicare Supplement insurance is a type of plan that you purchase from private health insurance companies, which helps you pay costs that Original Medicare doesn’t cover.
We hope this has been helpful!
Take a moment to learn about finding a plan that’s right for you.
Have more questions?
Our Medicare experts have the answers. Call 1-888-995-2583 (TTY: 711) from 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, April 1 through September 30, or seven days a week, October 1 through March 31.
