Medicare
Understanding Medicare Basics
Once you know the basics, Medicare becomes easier to understand. Learn about the fundamentals to get a better understanding of what you can expect from your Medicare coverage with Blue Cross and Blue Shield of Illinois.
How Does Medicare Work?
On this page you can learn:
- Who is Eligible for Medicare
- How Medicare works
- What each Part of Medicare covers
- How to choose coverage that fits your needs.
Who is eligible for Medicare?
Most Americans are able to join Medicare when they turn 65, but you may be eligible to get Medicare earlier if you:
- Have a disability
- Have End-Stage Renal Disease (ESRD)
- Have ALS (also called Lou Gehrig’s disease)
What is Medicare?
Medicare is a national health insurance program administered by the federal government. It is not part of the health insurance marketplace.
Understanding Medicare Parts vs. Medicare Plans
Many people confuse Medicare Parts and Medicare Plans. Here’s what you need to understand the difference between them:
Medicare Parts
Medicare is made up of four parts which cover specific benefits like hospital or doctor visits, medications, and more. These four parts are:
- Part A: Hospital coverage
- Part B: Medical coverage
- Part C: Medicare Advantage plans
- Part D: Prescription drug coverage
Medicare Plans
Medicare Supplement Insurance is made up of plans. Medicare Supplement Insurance Plans cover certain costs that the Medicare Parts do not.
Different Medicare Supplement Insurance Plans cover different types of costs.
Most people have Original Medicare Part A (hospital insurance) and Part B (medical insurance).
Some people may have Part C, a Medicare Advantage plan that combines Part A and Part B, with additional benefits.
Other people may have Part D, a prescription drug plan.
Medicare Coverage Options
When you sign up for Medicare, there are several options to choose from when selecting your coverage.
Original Medicare (Parts A and B)
Original Medicare is offered by the federal government. It consists of Parts A and B.
Part A: Hospital Insurance
- Inpatient hospital care
- Skilled nursing facility care after a hospital stay
- Some home health care and hospice services
Part B: Medical Insurance
- Doctor's office visits and services
- Most outpatient care
- Home health care
- Durable medical equipment
- Many preventive services
Medicare Advantage - Part C
Medicare Parts C and D can offer coverage beyond Original Medicare such as prescription drug coverage and even dental benefits. Medicare Part C, or Medicare Advantage, combines Part A and B of Original Medicare with added benefits.
Medicare Advantage plans are offered through private insurance companies.
Part C: Bundles Part A, Part B, plus additional benefits (often including Part D)
Part C always covers you for all benefits included in Parts A and B.
Part C coverage may also include:
- Dental, hearing and/or vision services
- Health, wellness and fitness programs
Additional benefits may include:
- Options that may or may not include prescription drug coverage
- Provider networks to help manage costs
- A Part B Premium Buy-down benefit that reduces the Medicare Part B premium that you pay to the Social Security Administration
- A preloaded flexible spending card to help reduce your out-of-pocket expenses for covered dental, vision, and hearing services
Medicare Prescription Drug - Part D
You may enroll in a Part D plan to get prescription drug coverage through Medicare.
You may choose a standalone Part D plan with Original Medicare or bundle Part A, B , and D coverage in a Medicare Advantage Prescription Drug Plan.
Part D Prescription Drug coverage helps pay for prescription drugs with copays or coinsurance.
Learn more about Medicare Part DMedicare Supplement Insurance Plans
Medicare Supplement Insurance Plans can help cover certain costs with Original Medicare. The plans are lettered with each plan offering different benefits. Medicare Supplement Insurance Plans are available through private insurance companies.
You can choose to enroll in a Medicare Supplement Insurance Plan on its own or paired with a Part D plan. If you are enrolled in a Medicare Advantage plan, you cannot also enroll in a Medicare Supplement Insurance Plan.
Medicare Supplement Insurance Plans help pay for:
- Coinsurance
- Copays
- Deductibles