Arkansas Blue Cross and Blue Shield
Medicare 101 Video Series
“Joining a Medicare Plan”
If you’ve recently enrolled in Medicare, congratulations! You‘ve taken the first step in extending your health care coverage. For many people, making a decision about what to do after enrolling in Medicare is difficult. At Arkansas Blue Cross and Blue Shield, we understand that insurance is complex and this is a new phase of your life with new decisions to make. We have the expertise to guide you through this process and help you choose the insurance coverage that fits your health and budget needs. Not only is it important to know what options are available as you turn 65, but also to know when to enroll in a Medicare-approved plan.
Many of our customers choose to buy a Medicare supplement or “Medigap” plan to coordinate with their Medicare Part A and Part B (“Original” Medicare) coverage. As its names implies, a Medigap plan fills in the “gaps” that Original Medicare does not cover. Many people choose a Medicare supplement because — although the monthly premium may be higher than a Medicare Advantage plan (which we’ll discuss later) — it’s important to them not to have any out-of-pocket costs when receiving health care services.
Your decision regarding when to apply for a Medicare supplement plan may be affected by your availability of employer-sponsored health insurance. If you plan to continue working past age 65 or if you are eligible for your spouse’s group insurance, you may want to defer your enrollment in Medicare Part B and delay purchasing a Medicare supplement plan.
Otherwise, you’ll want to apply for a Medicare Supplement Plan within six months of turning age 65 and going on Medicare Part A and Part B. If you apply within this six-month period, OR within 63 days of losing your employer group health coverage, you will be guaranteed coverage in certain Medicare Supplement plans, regardless of any health conditions you may have.
You can apply for a Medicare Supplement plan anytime as long as you are enrolled in Medicare Parts A and B, but if you miss one of the guaranteed opportunities – like those previously described – your health condition will be considered and you may or may not be able to get Medicare Supplement coverage. Your acceptance will be based on your answers to health questions.
Because Medicare Part A and B, and Medicare supplement plans do not cover prescription drugs, most people also choose a Medicare Prescription Drug Plan – or PDP – when they turn 65 or when they lose their “creditable” prescription drug coverage available through their employer. Creditable prescription drug coverage simply means coverage that is good as or better than a Medicare prescription drug plan.
There are several time periods established by Medicare in which you can enroll in a PDP. You may enroll in a PDP three months prior to the month of your 65th birthday or up to three months after your birthday month. This is called your “Initial Enrollment Period.” If you miss your Initial Enrollment Period, then there are other opportunities for purchasing a PDP.
There is the Medicare Annual Election Period, which runs from October 15th through December 7th each year. During this period, you can add, drop or switch your PDP coverage. Any coverage added or changes made during this time are effective January 1st of the following year.
Medicare also has Special Election Periods in which you may be able to enroll in a PDP. Medicare’s Special Election Periods were designed to accommodate people experiencing certain life changes. For example – as we just mentioned –people leaving employer-sponsored or group creditable coverage. This is one of the most common changes that qualifies as a Special Election Period for enrolling in a PDP. Your Arkansas Blue Cross representative will help you understand other Special Election Periods.
Now, let’s discuss when you can enroll in a Medicare Advantage plan. Medicare Advantage plans offer all the benefits of Medicare Parts A and B, with many extras. People who want a product with a premium lower than a Medicare supplement may choose a Medicare Advantage Plan. Medicare Advantage Plans feature predictable out-of-pocket costs, and many extras not offered through Medicare alone.
If you are interested in a Medicare Advantage plan, you also have certain times in which to enroll. Now, some of this may sound a bit familiar. Similar to Medicare prescription drug plans, you may enroll in a Medicare Advantage plan during your “Initial Coverage Election Period.” That timeframe is the three months before your 65th birthday, the month you turn 65, and the three months following your 65th birthday.
If you miss your Initial Coverage Election Period, then there are other opportunities to purchase a Medicare Advantage plan. Like a prescription drug plan, you can enroll in a Medicare Advantage Plan during Medicare’s Annual Election Period, October 15th through December 7th each year. During this period, you can enroll or switch your Medicare Advantage coverage. Any coverage added or any changes made during this time are effective January 1st of the following year.
And again, Medicare also has Special Election Periods in which to enroll in a Medicare Advantage plan. Like Medicare prescription drug coverage, Medicare’s Special Election Periods were designed to accommodate people experiencing certain life changes, such as leaving employer-sponsored or “group” coverage. For more specific details, an Arkansas Blue Cross and Blue Shield representative will be happy to help explain.
We realize this is a lot of information to sort through and consider, and you still may have questions. Let us help make things more clear. We want you to have the peace of mind that comes from knowing your health care is covered as you turn age 65 and that you are taking the right steps at the right time. If you’d like to speak with someone by telephone or face-to-face, we’re here to help. Our representatives are knowledgeable and eager to assist you. We’ve been helping Arkansans get answers about health care insurance coverage to meet their needs for more than 60 years. Speak to us today.