What is Original Medicare?
Created in 1965, Medicare started with just two parts— Part A and Part B. Part A covers inpatient care, including care received while in a hospital or skilled nursing facility and, in limited circumstances, care received at home.
Part B covers doctor visits and many outpatient services, such as lab tests, X-rays and physical therapy.
What is Medicare Advantage (Part C)?
Medicare Advantage (MA) plans are health plans offered by private organizations, like Florida Blue Medicare, that contract with Medicare. It combines Original Medicare Part A and Part B in one plan, plus some or all out-of-pocket costs not covered by Parts A and B, like deductibles, copays and coninsurance.
What is Medicare Part D?
Standalone Part D prescription drug plans (PDPs) can help reduce your costs for medications and are available only from private companies or organizations like Florida Blue Medicare.
How can I get dental and vision coverage with Medicare?
Original Medicare includes limited dental and vision coverage. Medicare Advantage plans from private companies like Florida Blue, often include dental and vision benefits beyond those provided by Original Medicare.
How do I know if I’ll be able to see my same doctor when I’m on Medicare?
Talk to your doctor to see if they accept Medicare patients. Or call one of our agents who can help you see if your doctors are in our plans’ networks
What happens if my doctor leaves my Medicare Advantage plan’s network?
It’s best to check with your doctor before any appointment to make sure they are still in the Medicare Advantage plan network. If they are not in the plan, you might have to change to an in-network doctor or pay out-of-pocket for services or pay higher cost-sharing than if you received care from a network provider.
I can’t afford to pay for Medicare – not even the Part B premium. Where can I get help?
Medicare has an Extra Help program to help people with limited income and resources pay Medicare prescription drug plan costs, such as premiums, deductibles, and coinsurance. Medicare Savings Programs (MSP) are federally funded programs administered by each individual state. These programs are for people with limited income and resources and help pay some or all of their Original Medicare premiums, deductibles, copays and coinsurance.
What happens if I don’t sign up for Parts B & D when I become eligible?
If you do not enroll in Medicare Part B and/ or Part D when you are first eligible to enroll, you may have to pay a Part B and/or Part D late enrollment penalty if you later decide to sign up for them. Visit www.medicare.gov to find out more about these penalties, including situations in which you can wait to enroll in Part B and/ or Part D and not have to pay a late enrollment penalty.
What if I am working past 65?
Talk to your employer’s human resources department before you enroll in Medicare. If your employer doesn’t require you to sign up for Medicare right away to keep your employer-sponsored coverage, you may not need to do anything until you retire or lose your coverage.
Can I keep the same Medicare Advantage plan if I move?
You can keep your Medicare Advantage plan if you remain within the plan’s service area. If you move outside the service area you will qualify for a Special Enrollment Period (SEP) to choose a new plan.
How much does a Medicare Advantage plan cost?
You can estimate your monthly premiums for each Florida Blue Medicare plan in our shopping tool on our website at floridabluemedicare.com/ guide. You can also speak with a Medicare agent.
What if I need a drug that isn’t on the formulary or costs too much?
Generally, drugs not on the formulary are not covered. Ask your doctor if there is a drug available that is on your plan’s formulary, but if there are no covered drugs available, you may have to pay full price instead of a copayment or coinsurance, unless you qualify for a formulary exception. Check with your plan to request a formulary exception. If your doctor believes your health requires a certain drug and there are no lower-cost alternatives available, they can ask for a tiering exception, which is another type of formulary exception. If you get a tiering exception, you will pay the cost-sharing that applies in a lower tier.
What if I travel outside the state?
All Medicare Advantage plans are required to cover emergency care and urgent care no matter where you receive it. Your cost-sharing will be the same as if you had used a network provider in your plan’s service area. Some plans include comprehensive coverage. Check with your plan to see if you do.