Welcome to “Help with Health Care,” a short online series designed to help you better understand health care and health insurance. We know health care and health insurance can be confusing. We're always here to help. If you have any questions about health insurance, speak with a Medicare Benefit Consultant today.
Help with Health Care: Understanding Medicare
Virtual Medicare 101
We're here to make the process easier for you. In our seminar, you'll learn when to enroll, questions to ask and where to find important information.
Questions?
Speak with a Medicare Benefit Consultant today:
1-888-790-2397 (TTY 711)
Oct. 1 - Mar. 31, 8 a.m. - 8 p.m., 7 days a week
Apr. 1 - Sept. 30, 8 a.m. - 8 p.m., Monday - Friday
ABCD's of Medicare
Medicare helps cover the cost of health care and is made up of four parts, Parts A, B, C and D that all offer different types of coverage.
Part A - Hospital
Part B - Medical
Part C - Medicare Advantage
Part D - Prescription Drug
Part A: Benefit Period
We'll explain Medicare Part A benefit periods, how they work, and ways to help cover some of the associated costs.
What’s a benefit period?
A benefit period begins the day you’re admitted to a hospital or skilled nursing facility. The benefit period ends when you haven’t received inpatient hospital care or care in a skilled nursing facility for 60 days in a row.
What are the costs associated with your part A inpatient hospital care?
With Original Medicare, you’re responsible for part A hospital inpatient deductibles and coinsurances. You pay a deductible or out-of-pocket amount, for each benefit period. After 60 days, you pay additional per day coinsurances
Original Medicare Part A hospital stay costs can add up, but there are options available to help alleviate some of the burden.
Medigap, or Medicare Supplemental plans, can help you avoid paying high costs for your Part A hospital stays. With a Medigap plan, your Original Medicare pays first and the Medigap plan pays second. Most Medigap plans will cover the Part A deductible and associated coinsurance amounts.
Another option, Medicare Advantage, this plan becomes your primary insurance instead of Medicare. Most Medicare advantage plans have a per-day hospital copay for inpatient stays. Medicare Advantage plans also have a yearly out-of-pocket maximum, so there’s a limit on how much you pay in a plan year for covered services.
Part B: In the Know
We’re going to talk about Medicare Part B, how it works, and when you need to apply for it. Medicare Part B is the medical insurance of your “Original Medicare.” You must meet an annual deductible before Medicare begins to pay for your Part B benefits.
Not every Medicare beneficiary is required to take Part B when they turn 65. If you choose to continue working, you’re still eligible for Medicare, but now you can decide how and when you want to take Medicare Part B.
Once you decide to retire or you decide to leave work, then you’re entitled to a special enrollment period which is also known as an S-E-P. You have eight months to use this special enrollment period to avoid any Part B late enrollment penalty.
You must contact the Social Security Administration to apply for Part B by phone or by downloading the application from their website at ssa.gov. We recommend starting this process 30 to 60 days before your retirement or loss of coverage date to avoid any lapse in your insurance coverage.
Diabetes Management
All Medicare Advantage plans cover the same diabetic supplies and medications that Original Medicare covers, like glucose monitors, insulin, insulin pumps, and test strips. Our Medicare Advantage plans go above and beyond this coverage and give you more opportunities to save and better manage your diabetes.
We want to help you lead the healthiest life possible. That’s why we offer programs and one-on-one phone counseling to help you better manage your diabetes. Our care management team can work with you and your doctor… all at no cost.
Highmark Blue Cross Blue Shield of Western New York wants to help you manage your diabetes. That's why we've partnered with Livongo®, a technology tool with coaching support, offered at no cost to Medicare Advantage members. Livongo provides an easy and convenient way to keep track of your health with a smart glucose meter, unlimited testing supplies, and health coaching — all through your cell phone.
Losing Employer Coverage
If you’re within three months of your 65th birthday, are over 65, or have certain qualifying disabilities or conditions, there’s good news.
You will need both Original Medicare Part A, hospital coverage, and Part B, medical coverage. In addition, you have Medicare Advantage Part C plan options. These plans generally cover hospital, medical, and prescription drug coverage, as well as other added benefits like dental, vision, hearing, gym memberships, and more.
If you’re under 65, you still have a few options.
- COBRA gives workers and their families who lose their health benefits a choice to continue group health benefits provided by their group health plan for limited periods of time.
- Individual and Family plans can either be purchased through the New York State of Health exchange at nystateofhealth.ny.gov, or through one of our representatives.
- You and your children may also be eligible for Medicaid, the Essential Heath Plan, or Child Health Plus. Based on your household size, income, and other factors, you may qualify for one of these low or no-cost health options.
Highmark Blue Cross Blue Shield of Western New York (BCBSWNY) is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal. Highmark BCBSWNY complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia linguistica, Llame al 1-833-735-4515 (TTY 711) 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-833-735-4515 (TTY 711)
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Content Last Updated: October 1, 2021