Demystifying Medicare with Blue Cross Blue Shield Massachusetts Expert Gloria Paradiso

Sponsored by Blue Cross Blue Shield of Massachusetts

Choosing a Medicare plan is a significant decision that can affect both your health and your finances. With so many options, it’s important to understand how to pick the plan that best suits your needs.

To help simplify the process, Gloria Paradiso, Head of Government Sales at Blue Cross Blue Shield of Massachusetts, answers common questions to guide you through Medicare enrollment.

Q: Why do people find Medicare confusing?

A: Many are used to employer-sponsored coverage, so navigating Medicare for the first time can feel overwhelming. There are no family plans in Medicare – each person enrolls individually, often at different times – and there are multiple parts and options. People also confuse Medicare with Medicaid. Medicare is medical coverage for people who are over 65+ or with have certain conditions, while Medicaid is a separate program based on income.

Q: How do I know if I’m eligible for Medicare?

A: As you approach 65, you’ll begin receiving mail about Medicare enrollment. Generally, you’re eligible if you’re turning 65 or have certain qualifying conditions.

Q: Do I automatically get enrolled in Medicare at 65?

A: No. You need to enroll during your Initial Enrollment Period unless you’re covered by an employer plan. Missing your enrollment window could result in penalties.

Q: What are the different parts of Medicare?

A:

• Part A (hospital insurance) and Part B (medical insurance) make up Original Medicare, covering hospital stays, doctor visits and outpatient care. These plans typically provide coverage for 80% of medical costs.

• Part C (Medicare Advantage) plans are offered by private insurers like Blue Cross and provide full coverage including prescription drug coverage along with added benefits that may include vision and hearing coverage allowances and dental coverage.

• Part D covers prescription drugs. If you enroll in Part C, you do not need Part D.

Q: How should I decide which plan is right for me?

A: Start by assessing your health needs and budget. Here’s what to consider:

When you come to the table to decide the best plan for you, be prepared to discuss:

• Current Health: Do you visit specialists or have ongoing health conditions?

• Doctors and Hospitals: Do your preferred providers accept Medicare? If you choose a Medicare Advantage plan, ensure they’re in network.

• Prescription Drugs: Check that your medications are covered under your plan.

• Extra Benefits: Medicare Advantage often includes dental, vision, hearing and wellness perks like gym memberships.

Cost is another key factor. Think about monthly premiums, deductibles, and out-of-pocket costs. If you travel frequently, ensure your plan offers coverage outside your local area.

For those feeling overwhelmed by the process, Blue Cross Blue Shield of Massachusetts offers resources designed to help you navigate your options and make informed decisions.

Q: What are the key deadlines I need to know?

A:

• Initial Enrollment Period (IEP): Begins three months before your 65th birthday month and lasts seven months.
• Medicare Annual Open Enrollment Period: October 15 to December 7 each year. You can change your Medicare plan for the upcoming year during this time.
• Medicare Open Enrollment Period: January 1 to March 31, when you can switch Advantage plans.

Q: Are there any changes to Medicare for 2025?

A: Two significant updates include: (1) a $2,000 annual cap on out-of-pocket prescription costs for those with Part D coverage and (2) Medicare Advantage members will now receive personalized mid-year notices about unused supplemental benefits.

Q: How easy is it to switch plans?

A: Switching is straightforward. You can change plans during the enrollment periods mentioned above. Many use Medicare.gov to compare options or work with private insurers like Blue Cross Blue Shield of Massachusetts to ensure they find the right fit.

Q: Why is enrolling in Medicare important?

A: Enrolling on time helps you avoid financial penalties and ensures you’re covered for essential healthcare needs. While Original Medicare covers a lot, it does not include everything – Medicare Advantage or supplemental plans can help full in those gaps, covering things like dental, hearing and vision.

Thanks to Blue Cross Blue Shield of Massachusetts for sponsoring this Westwood Minute article.

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