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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

Understand the difference between Original Medicare and Medicare Advantage.

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

Learn more about what your plan offers

Ways to Get the Most from Your Benefits

Learn about what your plan pays and what you pay for your prescription medicines.

Understanding Medicare Part D

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