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Getting to Know Medicare

Valuable guidance and important information for a better understanding of Medicare.

Learning More About Your Medicare Plan

When you enroll in Original Medicare, you get Part A Hospital coverage and Part B Medical coverage. But Original Medicare doesn’t cover all of your medical costs. If you want prescription drug coverage, you can buy a separate Part D plan. Or, you may decide to get all your coverage in one plan from a private insurance company, like Horizon BCBSNJ. Part C – Medicare Advantage – gives you all the benefits in one convenient plan, often including Part D, as well as other extra benefits like vision, hearing and dental.

Understanding How Medicare Works

After you’ve enrolled in the Medicare plan that best suits your needs, you’ll want to understand how it all works so get the most from your plan.

Learn more about the different parts of Medicare.

The A, B, C D’s of Medicare

The A, B, C D’s of Medicare

Transcript

What is Medicare?

It’s a federal health insurance program for people who are age 65 or older, disabled, diagnosed with end-stage renal disease needing dialysis or a kidney transplant.

There are four basic parts to Medicare. They are called Parts A, B, C and D.

Let’s take a look at what each part covers and what it may cost you.

Part A covers hospital services, hospice care, care in a skilled nursing facility, some home health care.

Most people don’t pay a monthly premium for Part A.

Part B covers doctors visits, outpatient care, medical supplies, preventive services.

You generally have to pay a standard monthly premium for Part B. The premium is updated by the federal government each year and deducted from your Social Security check. Parts A and B are called Original Medicare and are run by the federal government.

Part C is also known as Medicare Advantage. It is a type of plan provided by private insurance companies that contract with the federal government.

Think of Part C as an all-in-one type of plan. It covers everything Parts A and B cover, and many plans provide extra benefits such as prescription drugs, dental, vision, hearing and more. Plus, when you enroll in a Medicare Advantage plan, there are people who help you coordinate your care. You are not on your own. Depending on your plan, you may pay a low or no monthly premium; preventive visits and screenings are covered at no cost; and unlike Original Medicare, there is an annual limit for out-of-pocket costs in case you get really sick.

Part D refers to prescription drug coverage provided by private insurance companies.

Part D covers generic and brand-name prescriptions. Before you purchase a plan, take a look at the drug list, also called a formulary, to make sure your medications are covered. You generally pay a monthly premium that varies by plan.

Get to know the basic parts of Medicare.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

Understand the difference between Original Medicare and Medicare Advantage.

Original Medicare or Medicare Advantage – What’s the difference?

Original Medicare or Medicare Advantage – What’s the difference?

Transcript

Choosing a Medicare plan can be very confusing. For example, what’s the difference between Original Medicare and Medicare Advantage plans?

Let’s take a closer look.

Original Medicare helps pay for hospital, skilled nursing and hospice care. It also pays for doctors’ visits and outpatient care, including physical and occupational therapy.

However, Original Medicare doesn’t cover expenses for dental, vision, hearing or prescription drugs.

What does Medicare Advantage cover?

Medicare Advantage offers all of the benefits of Original Medicare, and includes extra benefits such as dental, vision, hearing and wellness programs.

Many Medicare Advantage plans include reimbursement for gym or yoga studio memberships, activity trackers, weight management programs, and more.

Other benefits, like care managers to help coordinate care and in-home visits and preventive screenings, are also included.

Original Medicare doesn’t offer any of these benefits.

There are Medicare Advantage plans that also offer prescription drug coverage. One of the reasons these types of Medicare Advantage plans are so popular is because you don’t need to get separate prescription drug coverage.

Everything is included in one plan.

Many plans have low or no premiums. Plus, there is a maximum limit to your out-of-pocket costs, so if you become sick and have a long hospital stay, there is a limit on the amount you will be required to pay.

Original Medicare doesn’t provide a maximum limit.

Choosing Medicare Advantage will give you the coverage and support you need, all in one plan.

Once you understand the differences, you can decide if a Medicare Advantage plan is the right choice for you.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

Learn more about what your plan offers

Ways to Get the Most from Your Benefits

Ways to Get the Most from Your Benefits

Transcript

As a Medicare Advantage plan member with Horizon Blue Cross Blue Shield of New Jersey, you have the trust and confidence of knowing you’re covered by the largest and most experienced health insurer in New Jersey.

When you need to see a doctor or specialist – or have to get lab tests or go to a hospital – our network of health care professionals and facilities offer quality care across the state.

But did you know there are ways to get more from your benefits? Let’s take a look.

The first way is to build a relationship with your Primary Care Physician, who can help you get healthy and stay healthy. How? Your PCP provides preventive care to monitor your health and well-being – all at no cost to you.

Your doctor can identify risk factors and symptoms that lead to chronic conditions or disease, and can help coordinate your care with other doctors or specialists.

So watch for reminders when you’re due for preventive care. We’ll tell you when it’s time to get your flu shot, diabetes screening, or other certain cancer screenings.

And, when you get certain preventive screenings, you can earn rewards in gift cards.

Another valuable way to get the most from your plan is by saving money on your prescription medications.

When you fill your prescriptions at a preferred pharmacy – including many popular retail chains such as Walgreens or CVS – you’ll save on the cost of your medications.

You can save even more when your doctor prescribes generics over brand-name drugs. Our pharmacy website can help you figure out the best possible savings.

For added convenience, many medications are available through our pharmacy mail order service – and can be delivered right to your door.

What about when you have a chronic condition? Our dedicated Care Managers help coordinate all of your healthcare needs and can help you understand what’s covered under your plan

Care Managers identify your specific needs and develop a custom plan to help you manage ailments such as diabetes or high blood pressure. They can also help arrange services for you and can help you access other valuable resources.

How about when you need answers to health questions or wellness advice? Our 24/7 Nurse Line is available around the clock for reliable information on getting and staying well.

You’ll get safe, expert advice, and you can either call or chat online about any symptom or illness, or ask about any health-related concerns.

You can also get convenient medical care by phone or online via chat or video. Members can talk with a U.S. board-certified licensed doctor, 24 hours a day, 7 days a week – no appointment needed.

What’s more, you can easily access all of your plan information by registering and signing in to our secure member website at HorizonBlue.com.

With 24/7 access to all the details of your plan, you’re connected to care and support when and where it’s convenient for you. You can find a doctor, check claims, view your ID card and more.

Understand and make the most of your Horizon Medicare Advantage plan today.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

Horizon Medicare Advantage: New Member Checklist

If you’re new to Medicare Advantage and have your member ID card, you’re ready to get started. Use this checklist to make the most of your benefits.

Seven ways to make the most of your benefits:

  1. Register or sign in to our secure website to access your plan information.

    It has helpful tools to:

    • View your coverage details
    • Find doctors and hospitals near you
    • Access health and wellness tools
    • Get forms you may need
    • Check claim information

  2. Download our Horizon Blue app for access to care wherever you are.

    The Horizon Blue mobile app is your 24/7 connection to the ins and outs of your plan. Text GetApp to 422-272. It’s free to download, and easy to use. You can access your benefits, display your ID card, find doctors, get support and more

  3. Know which doctors and hospitals are in network.

    You must choose doctors, hospitals or other health professionals in our network. It’s easy to see who is in network by searching our Doctor & Hospital Finder on HorizonBlue.com/doctorfinder. The only exception is if you are a member of our Horizon Medicare Blue Select (HMO-POS) plan, which allows you to see out-of-network providers; however, you’ll pay less if you choose doctors, hospitals or other health professionals in our network.

  4. Check out your pharmacy benefits.

    Find out if your medications are covered by calling Pharmacy Member Services at 1-800-391-1906 (TTY 711) 24 hours a day, seven days a week. Our network includes many well-known retail pharmacies like CVS, Shoprite and Walmart, as well as many privately owned pharmacies, home infusion pharmacies and long-term care pharmacies.

    You may be able to save money if you:

    • Call your doctor or pharmacist to see if a generic drug is available.
    • Get your medications through home delivery mail order.
    • Use preferred pharmacies. Look for the yellow “P” pin when searching the Pharmacy Directory at HorizonBlue.com/ma-pharmacy-search to locate pharmacies with preferred cost-sharing. They may offer you even lower costs than the standard cost sharing offered by pharmacies in our network.

  5. Make an appointment with your doctor.

    Your annual wellness visit and most preventive screenings are covered at no cost to you. It’s a good idea to see your doctor each year so your health problems are addressed early and don’t turn into serious issues. When you speak with your doctor, you should also find out which preventive screenings are appropriate for you.

  6. Get help from one of our Care Managers to help coordinate care for chronic conditions.

    With a Medicare Advantage plan, you’re not on your own. Our Care Managers are available to develop a plan of care for you to help you better manage your health conditions, and arrange for other services or resources you may need. They are available Monday through Friday from 8 a.m. to 5 p.m., ET at 1-888-621-5894 (TTY 711), prompt 2.

  7. Enroll in Horizon CareOnlineSM to visit a doctor without leaving your house.

    Talk with a U.S. board-certified medical doctor via video, chat or phone 24/7 to get help with colds, ear infections, flu, fever, pinkeye, rash, migraines, rash stomach pain, sinusitis, and more. Visit HorizonCareOnline.com or call 1-877-716-5657 (TTY 711 ), 24 hours a day, seven days a week, to get started.

    At Horizon Blue Cross Blue Shield of New Jersey, we want you to understand your choices on your journey to better health. Help is always a phone call away. Call Member Services at 1-800-365-2223 (TTY 711). Representatives are available Monday through Friday from 8 a.m. to 8 p.m., Eastern Time (ET).

 

How does my other insurance work with Medicare?

When you have other insurance and Medicare, there are rules for whether Medicare or your other insurance pays first.

  • If you have retiree insurance (insurance from your or your spouse’s former employment): Medicare pays first.
  • If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has 20 or more employees: Your group health plan pays first.
  • If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has fewer than 20 employees: Medicare pays first.
  • If you’re under 65 and have a disability, have group health plan coverage based on your family member’s current employment, and the employer has 100 or more employees: Your group health plan pays first.
  • If you’re under 65 and have a disability, have group health plan coverage based on your or a family member’s current employment, and the employer has fewer than 100 employees: Medicare pays first.
  • If you have Medicare because of End-Stage Renal Disease (ESRD): Your group health plan will pay first for the first 30 months after you become eligible to enroll in Medicare. Medicare will pay first after this 30-month period.

Note: In some cases, your employer may join with other employers or unions to form or sponsor a multiple-employer plan. If this happens, the size of the largest employer/union determines whether Medicare pays first or second.

Here are some important facts to remember:

  • The insurance that pays first (primary payer) pays up to the limits of its coverage.
  • The insurance that pays second (secondary payer) only pays if there are costs the primary insurer didn’t cover.
  • The secondary payer (which may be Medicare) might not pay all of the uncovered costs.
  • If your employer insurance is the secondary payer, you might need to enroll in Part B before your insurance will pay.
  • Medicaid pays after Medicare.

Source: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES; Centers for Medicare & Medicaid Services; CMS Product No. 10050; Revised November 2018