Arkansas Blue Cross and Blue Shield

Medicare 101 Video Series

“Turning 65: Becoming Eligible for Medicare”

Whether you celebrate in grand fashion or prefer to keep it “low key,” your 65th birthday is a significant milestone. Welcome to a great new season of life and adventure! As you turn 65, you probably will have some questions about how and when to enroll in Medicare. At Arkansas Blue Cross and Blue Shield, we have the answers you need to make sure your health insurance coverage is in place as you prepare for your 65th birthday.

Medicare is not “automatic.” To enroll in Medicare, call or visit your local Social Security office. Most people sign up for Medicare during a seven-month period that begins three months before their 65th birthday, includes the month they turn age 65, and ends three months after the month of their birthday. This is called the “Initial Enrollment Period for Medicare Part B.”

When you sign up for Medicare, you will be enrolled in Medicare Part A, which provides insurance coverage for hospital services. There is no monthly premium for Medicare Part A. Medicare Part B is insurance coverage for doctor visits and other medical services. Medicare requires that you sign up for Part B. There is a monthly premium for Medicare Part B coverage. You may hear Medicare Parts A and B referred to as “Original Medicare.” People who are age 65, still working and covered by an employer-sponsored health plan – or are covered through their spouse’s employer-sponsored health plan – may choose to defer (or delay) enrollment in Medicare Part B.

Original Medicare alone was never intended to cover all of your healthcare costs — just a portion — and does not include coverage for prescription medications. Therefore, many people find they need more than Medicare Parts A and B to help cover out-of-pocket costs. To help pay for the health-care services Medicare does not cover, you have options — including Medicare Supplement plans, Medicare Advantage plans (called Medicare Part C plans) and Medicare prescription drug plans (called Medicare Part D). You choose the plan option or options that best meet your needs and budget.

Many of our customers choose a Medicare supplement plan. A Medicare supplement plan works with Medicare Parts A and B. It provides benefits to help pay Medicare’s deductibles and copayments that you’d otherwise have to pay out of your own pocket. These deductibles and copayments can amount to thousands of dollars each year. A comprehensive Medicare supplement plan picks up most, if not all, of the Medicare Parts A and B out-of-pocket costs for you. Medicare supplement plans are identified by the word “Plan” followed by letters, such as Plan A, Plan F or Plan G. The benefits of a particular plan type are exactly the same, regardless of the insurance company you choose. Important differences, however, are found in price and the service, experience and reliability of the insurance company from which you purchase the plan.

You are eligible to apply for a Medicare supplement plan if you are enrolled in Medicare Part A and Part B. If you’re turning 65 and decide to apply for a Medicare supplement plan, you can do that as early as six months prior to your Medicare Part A and Part B effective date. Medicare supplement plans do not include prescription drug coverage. Therefore, most people decide to buy a prescription drug plan to go along with a Medicare supplement.

The best time to buy prescription drug coverage is when you first become eligible for Medicare. If you wait, you may have to pay a penalty and you may not be able to have coverage at the very time you want it. Generally speaking, if you don’t enroll in a prescription drug plan when you’re first eligible, you will only be able to enroll during Medicare’s Annual Election Period held October 15th through December 7th.

Medicare does offer “Special Election Periods” designed to accommodate people experiencing certain life changes. For example, for people leaving employer-sponsored or group “creditable” coverage. “Creditable” coverage is drug coverage that is “as good as or better” than Medicare Part D (or Medicare prescription drug plans). This is one of the most common changes that qualifies as a Special Election Period for enrolling in a PDP. An Arkansas Blue Cross representative can explain other Special Election Periods for enrolling in a PDP.

To be eligible for a prescription drug plan, you must be entitled to Medicare Part A OR enrolled in Medicare Part B. Prescription drug plans are not the same across the board and vary greatly in benefits as well as cost, approved drug lists, and pharmacy networks. You should shop carefully for the drug plan that fits your needs.

Another option is to get both your medical benefits and prescription drug coverage all in one with a Medicare Advantage plan. A Medicare Advantage plan provides all the benefits of Medicare Parts A and B, plus added benefits and the protection of an out-of-pocket maximum. With a Medicare Advantage plan, the out-of-pocket maximum limits your out-of-pocket costs. This is something you won’t get with Original Medicare alone. Some Medicare Advantage plans include prescription drug coverage and some do not. No matter which kind of Medicare Advantage plan you choose, you must continue to pay your Medicare Part B premium, just as you would with a Medicare supplement plan.

You must be enrolled in both Medicare Part A and Part B to be eligible for a Medicare Advantage plan. If you are enrolling in a Medicare Advantage plan or Medicare prescription drug plan, generally speaking, you can do that two to three months prior to your Medicare Part A and/or Part B effective dates.

Remember, we’re here for you! Arkansas Blue Cross representatives are available to help you learn more about all aspects of the Medicare program. We want you to have the peace of mind that comes from knowing your healthcare is covered as you turn age 65. Please don’t hesitate to ask us. We’ve been helping Arkansans with their health insurance needs for more than 60 years. It is our privilege to serve your health insurance needs.