Understanding Medicare Coverage
Medicare is a federal health-care insurance program that provides coverage for important services, like hospital stays and outpatient care, to senior citizens aged 65 and older, people with disabilities, and people with certain terminal illnesses.
In most cases, you can enroll in Medicare three months before your 65th birthday. However, the effective date is the 1st of the month you turn 65. The enrollment window remains open during your birthday month and closes three months later. For example, if your birthday is on February 21, you can enroll between November 1 and May 31.
Medicare Parts A and B, also known as Original Medicare, form the foundation of most Medicare plans. Medicare Part A pays for hospital and inpatient care, while Part B covers most outpatient services.
However, Original Medicare may not cover all of your health-care needs. So, people turn to private Medicare providers for additional coverage:
- Medicare Advantage Plans:
Medicare Advantage plans combine the benefits of Parts A and B and offer additional benefits, like vision and dental plans.
- Prescription Drug Plans:
Medicare Part D provides coverage for prescription medications and certain vaccines. Many Medicare insurance companies include Part D in their Medicare Advantage plans or offer it as a stand-alone plan.
- Medicare Supplement Plans:
Medicare supplement insurance, or Medigap, helps cover out-of-pocket costs. There are 11 different plans that you could enroll in, according to the Michigan Department of Insurance and Financial Services.
Anthem Medicare Plans
Different health insurance companies provide coverage for Medicare Advantage, including Blue Cross Blue Shield. In other states besides Michigan, Blue Cross Blue Shield goes by the name Anthem.
There are two types of this carriers Medicare Advantage plans in Michigan: Anthem MediBlue HMO and Anthem MediBlue PPO. Anyone who is eligible for Medicare can choose to enroll in this coverage.
Anthem MediBlue HMO
A health maintenance organization (HMO) plan provides beneficiaries access to certain doctors and hospitals in its network. You can only see a provider within the plan’s network. HMO insurance policies have a smaller list of providers but usually have lower premiums and copays.
With an Anthem MediBlue HMO plan, you work with the same primary care physician for all regular care and routine screenings.
You could also receive the following benefits:
- Dental, vision, and hearing benefits
- Telehealth visits via computer, phone, or tablet
- Low deductibles, premiums, and copays
- Access to fitness benefits
Another thing to know about HMO plans is that you will likely need a referral to see a specialist or another provider. Blue Cross Blue Shield used to be very strict with referrals, but these standards are starting to relax.
Anthem MediBlue PPO
A preferred provider organization (PPO) plan offers a larger network of approved doctors and hospitals. You have more flexibility and fewer restrictions on who you can see for treatment. However, PPO plans usually have higher premiums and copays.
With Anthem MediBlue PPO plans, you can choose to work with a primary care physician, but unlike an HMO plan, this is not necessary. If you need to see a specialist or another doctor, you do not need a referral either. You can also see out-of-network providers, but your costs may be higher.
You also receive many of the same benefits as the HMO plan:
- Dental, vision, and hearing benefits
- Fixed copays, low deductibles, and low premiums
- Access to fitness benefits and telehealth visits
Blue Cross Blue Shield Medicare Advantages
Blue Cross Blue Shield’s insurance offerings can deliver a lot of advantages for Medicare beneficiaries. Here are some of the most impactful benefits:
- A Wide Network: Blue Cross Blue Shield is a major health insurance company in the United States, offering Medicare Advantage plans in 47 states. You’ll likely find a provider near you.
- Low-Cost Plans: Cost is one of the biggest advantages of Blue Cross Blue Shield Medicare Advantage plans. These plans have low, and sometimes free, monthly premiums and often come with $0 copays and deductibles.
- Extra Allowances: Some Blue Cross Blue Shield plans come with money for extra benefits. Some plans offer between $25 and $100 per quarter to pay for services like healthy food and over-the-counter supplements.
- Concierge Services: Blue Cross Blue Shield offers a concierge service to answer any questions that you may have. You can ask how to manage your benefits or access certain types of care.
Blue Cross Blue Shield Medicare Disadvantages
Like all Medicare plans, there are some disadvantages to choosing Blue Cross Blue Shield. It’s important to keep the following points in mind:
- Company Strength in Michigan: While Blue Cross Blue Shield is a major health insurance carrier in the United States, its strength is not consistent across the country. Depending on where you live, you may not have access to a high-rated provider or plan. It’s important to look at what is available in your area.
- Limited Plans for Special Needs: If you have a certain disease or need extra medical care, then you may want to purchase a Medicare Special Needs Plan. These plans limit membership so that they can cater to the right beneficiaries. However, Blue Cross Blue Shield has limited Special Needs Plans compared to other Medicare providers.
It’s also important to remember that Medicare plans are highly personalized. While Blue Cross Blue Shield may not be the right provider for some people, its coverage does fit into others’ health-care plans.
To ensure that you enroll in the right Medicare Advantage plan, you need a licensed agent on your side. At Sunnyside Medicare, we work equally well with every provider. As long as a carrier’s benefits meet our clients’ needs, we can help them enroll in the best plan for their unique health-care needs.
Learn More About Blue Cross Blue Shield Medicare Coverage
Blue Cross Blue Shield health insurance plans can be a good option, but they’re not the right choice for everyone. To learn how this coverage can fit into your Medicare plan, speak to a licensed agent at Sunnyside Medicare.
We’ll carefully assess your health needs, financial situation, and coverage options to determine if Blue Cross Blue Shield is right for you. If it isn’t, we can introduce you to alternative options that better meet your health-care needs.
The Medicare landscape can be complex, so don’t go it alone. Trust the experts at Sunnyside Medicare. Contact us today to learn more about our no-cost service.
Looking for a Helping Hand?
Call us at 1-248-277-5948 to talk with a Sunnyside Agent. Our licensed Medicare Agents are friendly, knowledgeable and always willing to take the time to find the right plan for you! Not ready to talk on the phone? Send us an online message and an Agent will get back to you shortly. We look forward to helping you.