CareFirst BlueCross BlueShield of Maryland Medicare InsuranceAdvantage, Medigap Supplemental and Part D Prescription Drug Plans

CareFirst Blue Cross Blue Shield of Maryland offers Medicare Advantage, Medigap Supplemental Insurance and Medicare Prescription Drug Plans. If you're eligible for Medicare in Maryland, you can get health coverage through the Original Medicare plan alone. However, many people find that Original Medicare does not cover all their healthcare needs because many medical services and supplies are not covered.

What Medicare Covers.

When Medicare was created in 1965, it was never intended to fully pay for the medical expenses it covers. In fact, Medicare generally pays only 80% of covered medical services. Here’s how it works. Medicare is offered in 2 parts, Part A and Part B. Most people receive Part A automatically when they turn 65. If you OR your spouse paid Medicare taxes while working at least 40 quarters, you’ll have no premium to pay to get Part A. Those who are not eligible for premium-free Part A may be able to buy it if they didn’t work or didn’t pay enough Medicare taxes or are disabled and have returned to work. Part B is voluntary. You must first have Part A, then agree to pay a monthly fee if you want Part B coverage.

Why You Need More Than Medicare.

Medicare typically pays for only 80% of the medical services it covers. That leaves 20% — plus copays — for you. And 20% of even a common procedure can add up in ways you can’t imagine. That’s where Medigap coverage comes in. Depending on which Medigap plan you select (see Pages 8 & 9), it helps fill in gaps not covered by Medicare — starting with the 20% that’s NOT covered. Medigap also covers eligible deductibles and copays, extended hospital stays, outpatient services, tests and emergency care overseas. For instance, a single day in the hospital, even with Medicare coverage, can cost you over $1,100* if you don’t have Medigap coverage. That’s because under Medicare you’re responsible for deductibles and copays — both of which go up every year. Imagine how an extended stay could begin to add up. That’s why you need Medigap. To help fill in the gaps that Medicare doesn’t, so you can live the life you’ve imagined.

Medicare Supplemental Insurance or Medigap

Medigap offers 12 standardized plans plus 2 high-deductible standardized plans (starting June 2010 there will be 10 standardized plans and 1 high-deductible standardized plan). Each plan has different benefits that follow federal laws. Since the law standardizes all Medigap plans, the plans don’t vary from insurance carrier to insurance carrier. What does vary is the number of plans a carrier may offer — and the cost. One carrier may offer only 2 plans, for instance, while another may offer 10. CareFirst Blue Cross Blue Shield of Maryland offers a variety of Medigap plans.

Medicare Advantage Plans

In addition to the option of Medigap, you also have the choice of selecting Medicare Advantage as a way to enhance your Medicare coverage. Medicare Advantage plans take the place of Medicare (Parts A & B) and are not supplemental like Medigap. The 3 most popular Medicare Advantage or Part C plans are: Medicare Advantage HMO, PPO or Private-Fee-for-Service (PFFS). (See the chart at right) Medigap vs. Medicare Advantage Medigap and Medicare Advantage plans require that you be enrolled in Medicare Parts A and B. You also have a premium in addition to the Medicare Part B premium for Medigap and usually have an additional premium for Medicare Advantage as well. Basically, with Medicare Advantage your Medicare coverage is provided through 1 plan, which is managed by a private insurance company. Most Medicare Advantage plans also include Medicare Prescription Drug coverage, known as Part D, while Medigap plans do not include Part D coverage. If you select Medigap and want prescription drug coverage you will need to select a stand-alone Part D plan. CareFirst Blue Cross Blue Shield of Maryland offers several Medicare Advantage plans for seniors.

Medicare Advantage HMO

A plan option that may allow you to see only providers (doctors, hospitals, specialists) in the network. The insurance plan, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get. You can go out-of-network for emergency care. Many HMOs include additional benefits and typically have lower associated costs. Referrals may be required to see a specialist and precertifications beyond Original Medicare may be required prior to a hospital stay or getting durable medical equipment or obtaining other services. If precertifications are not obtained, services may not be covered or may be reduced.

Medicare Advantage PFFS

A plan with a network of providers (doctors, hospitals, specialists) where you may go to any Medicare-approved doctor or hospital nationwide that accepts the plan’s terms and conditions of payment. The insurance plan pays the same rates for services as original Medicare A & B. A doctor or hospital has the right to choose whether to accept the PFFS plan every time the member sees the provider.

Medicare Advantage PPO

A plan option where you may pay less if you use providers (doctors, hospitals, specialists) in the network. The insurance plan, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get. You may also be able to visit providers outside of the network but will have to pay an additional cost. Referrals are not required to see a specialist, though precertifications beyond Original Medicare may be required prior to a hospital stay, or getting durable medical equipment or obtaining other services.

Prescription Drug Coverage

The most recent addition to the Medicare Program is Medicare Prescription Drug coverage (Part D), created to help cover the costs of your prescription drugs. To enroll in a Prescription Drug plan, you must be enrolled in Medicare and pay an additional premium. There are a variety of Part D plans to choose from based on the drugs that are covered and the cost to you. Just like Medigap and Medicare Advantage, Part D is offered by private insurance carriers. There are now only 2 ways to get a Medicare Prescription Drug Plan (sometimes called a PDP). You can simply add a stand-alone PDP or receive it through most Medicare Advantage plans. For more information about CareFirst Blue Cross Blue Shield of Maryland prescription drug coverage complete the simple contact form at the top of the page.