Medicare Overview

Get to know the ABCDs of Medicare

Medicare was established in 1965 to help people who are 65 and over or have disabilities pay for the rising costs of medical care. Over the years, it has changed. Whether you are new to Medicare or want a refresher, here are a few resources to help you understand the costs, benefits, and choices offered by Blue.

Eligibility for Medicare

You are generally entitled to Medicare if you meet any of the following criteria:

  • You are age 65 or above
  • You already receive Social Security or Railroad Retirement Board (RRB) benefits
  • You have been diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, “Lou Gehrig’s disease”)
  • Under age 65 and are permanently disabled and have received Social Security disability payments for at lease 24 months

Your Initial Enrollment Period is based on the month in which you turn 65. It begins three months before your birth month and extends until three months after your birth month.

Medicare (Part A and Part B)

Medicare Part A is offered at no cost to most people eligible for Medicare. Medicare Part B is available for a monthly premium to most people eligible for Medicare. Medicare premiums, deductibles, and cost-sharing amounts are set by the federal government each fall for the next year.

Part A: Hospital Coverage

What's Covered

  • Inpatient hospital stays
  • Care in a skilled nursing facility
  • Home health care and hospice care

What's not Covered

You pay a share of the costs because of things like day limits, deductibles, and coinsurance

Part B: Medical Coverage

What's Covered

  • Doctor's services and tests
  • Outpatient Care
  • Durable medical equipment and some medical services
  • Supplies not covered by Medicare Part A. Part B also covers some preventive services

What's not Covered

Doesn't cover deductibles, copays, and coinsurance

Medicare Advantage (Part C)

With a Medicare Advantage plan, you get Medicare Part A and Part B benefits and some plans may offer extra benefits. Some Medicare Advantage plans also include prescription drug coverage in one plan. Like all Medicare plans, benefits, premiums, and copayments may change from year to year.

Part C: Medicare Advantage

What's Covered

  • Medicare Part A and Part B benefits
  • Some plans may offer extra benefits

What's not Covered

If you go to a doctor or other healthcare provider that does not belong to your plan's network, your services may not be covered or your costs could be higher. Medicare Advantage plans also require cost sharing such as coinsurance, copays, and deductibles

Prescription Drug Plans (Part D)

Medicare works with health plans and other private companies to offer prescription drug coverage. These Medicare-approved plans are called standalone Part D plans.

Part D: Prescription Drug Plans

What's Covered

  • Generic drugs
  • Brand-name drugs

What's not Covered

Not all Plans have the same formulary (the list of covered drugs) and you will need to use a network pharmacy to ensure your drugs are covered

Medicare Supplement Plans (Medigap)

Medigap plans are sold by private health coverage companies. They help pay for some of the healthcare costs or “gaps” that Medicare Part A and Part B don't cover. In most cases, you must be enrolled into Part A and Part B to purchase a Medigap policy. Medicare does not allow beneficiaries to be enrolled into both a Medicare Supplement and Medicare Advantage Prescription Drug Plan.

Medicare Supplement Plans (Medigap)

What's Covered

  • Your share of costs for services partially covered by Part A and Part B
  • Things that require out-of-pocket expenses like coinsurance, deductibles, etc.

What's not Covered

Most other costs not covered by Medicare

Additional Medicare resources and guides

If you are new to Medicare, you might like to start with a few of our resources, which can help you understand more, including how it works, what it covers, and what it doesn't. You will also find helpful information about the range of options available for those who are eligible for additional coverage, too.

Shop plans with Blue Cross Blue Shield of Arizona

For most people, original Medicare alone just isn’t enough coverage. That’s why Blue Cross Blue Shield of Arizona offers additional coverage options—like Part C, Part D, and Medicare Supplement (Medigap)—to help protect your assets and ease your family from financial burdens associated with the cost of care. Shop additional plans online today to see what level of coverage is right for you.

    Blue Cross® Blue Shield® of Arizona (AZ Blue) is contracted with Medicare to offer HMO and PPO Medicare Advantage plans and PDP plans. Enrollment in AZ Blue plans depends on contract renewal.

    AZ Blue offers BlueJourney PPO Medicare Advantage plans. AZ Blue Advantage, a separate but wholly owned subsidiary of AZ Blue, offers Best Blue Life Classic and Plus HMO plans.

    You are eligible to enroll in a AZ Blue Medicare Supplement plan if you are age 65 or older, entitled to Medicare Part A, and enrolled in Medicare Part B, and you live in the plan service area. You must continue to pay your Medicare Part B premiums (and Part A, if applicable), if not otherwise paid for by Medicaid or another third party. During the first six months when you are age 65 and also enrolled in Medicare Parts A & B you cannot be denied a Medicare Supplement plan when you apply for one, regardless of health status.

    Health Choice Pathway HMO D-SNP is a Health Plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Health Choice Pathway HMO D-SNP depends on contract renewal. Health Choice Pathway Member Services can be reached at 1-800-656-8991, TTY: 711, 8 a.m. to 8 p.m., 7 days a week.

    Blue Cross Blue Shield of Arizona (AZ Blue) and Health Choice Arizona (HCA) comply with applicable federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. We provide free aids and services to people with disabilities to communicate effectively with us, such as qualified interpreters and written information in other formats such as large print and accessible electronic formats. We also provide free language services to people whose primary language is not English, such as qualified interpreters and written information in other languages. If you need these services call 1-800-446-8331 (TTY: 711) for AZ Blue Medicare Advantage or 1-833-229-3593 (TTY: 711) for AZ Blue Blue MedicareRx (PDP) or 1-800-656-8991 (TTY: 711) for HCA.

    Member Services can be reached at 480-937-0409 (in Arizona) or at our toll-free phone number at 1-800-446-8331 (TTY users should call 711). Hours are 8 a.m. to 8 p.m., Monday through Friday from April 1 to September 30; and 7 days a week from October 1 to March 31. Member Services also has free language interpreter services available for non-English speakers.

    OptumRx® is an independent company providing prescription mail order services.

    Spanish (AZ Blue): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-446-8331 (TTY: 711).

    Navajo (AZ Blue): Díí baa akó nínízin: Díí saad bee yάnílti’ go Diné Bizaad, saad bee άkά’ άnída’ άwo’ dę͗ę͗, t’άά jiik’eh, éí nά hóló̖, kojí̖ hódíílnih 1-800-446-8331 (TTY: 711).

    Spanish (HCA): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-656-8991 (TTY: 711).

    Navajo (HCA): Díí baa akó nínízin: Díí saad bee yάnílti’ go Diné Bizaad, saad bee άkά’ άnída’ άwo’ dę͗ę͗, t’άά jiik’eh, éí nά hóló̖, kojí̖ hódíílnih 1-800-656-8991 (TTY: 711).

    AZBLUE SEN8 9/23
    Last Updated 01/01/2024