qualifies?is M

edicare?to begin

to get startedto enroll

choose IBX?WHO

WHAT

WHEN

WHERE

HOW

WHY

FAQs

1

An educational Medicare guide compliments of the Medicare Welcome Team

Y0041_HM_16_42450a Accepted (4/29/2016)

to MedicareWelcome

qualifies?WHO

are almost ready to enroll in Medicare, and

we would like to help make the process as

easy as possible. This Medicare Guide will

help you take an important step toward

gaining control of your health care needs

and expenses during retirement. Inside,

you’ll find important information regarding

the steps you should take leading up to

your Medicare enrollment. Please feel free

to contact us if you have any questions.

And, be sure to visit our Medicare website

created for people like you. You’ll find it at

www.ibxmedicare.com/guide.

You

Be sure to check out the FAQs. You may find answers before you even ask!

Independence Blue CrossMedicare Welcome Team

3

5

This quick list of Medicare-related terms will help you better understand the information in this Medicare guide.

Notes As you read through this Medicare Guide, write down your notes and questions. Reference this sheet when you have your in-home meeting, or discuss it over the phone with the Independence Blue Cross Medicare Welcome Team.

Deductible: The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Coinsurance: An amount you may be required to pay as your share of the cost for services or prescription drugs after you pay any deductibles. Coinsurance is usually a percentage (for example, 20 percent).

Copayment: An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or a prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.

Premium: The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.

Network: “Provider” is the general term we use for doctors, other health care professionals, hospitals, and other health care facilities that are licensed or certified by Medicare and by the state to provide health care services. We call them “network providers” when they have an agreement with our plan to accept our payment as payment in full, and in some cases to coordinate as well as provide covered services to members of our plan. Our plan pays network providers based on the agreements it has with the providers or if the providers agree to provide you with plan-covered services. Network providers may also be referred to as “plan providers.”

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Call 1-866-447-9281 (TTY/TDD: 711)7 days a week, 8 a.m. to 8 p.m.

Easy Reference Number: KDG4G3

Connect with us on Facebook: www.facebook.com/ibxmedicare

Visit www.ibxmedicare.com/guide for more information.

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is Medicare?

WHAT

Part A : Hospital Insurance

Helps cover: Inpatient care in hospitals and skilled nursing facilities, nursing home care, hospice, and home health visits.

You’re eligible if: You or your spouse paid into Social Security for at least ten years through employment, you are a citizen or permanent resident of the United States, and you are aged 65 or older.

Your cost: Part A is funded by Social Security payroll taxes and is free for most people who paid Medicare taxes while working.

Part B : Medical Insurance

Helps cover: Doctor visits, lab tests, outpatient services, and surgeries that don’t require an overnight hospital stay, plus some preventive services like annual checkups. It also covers some medical supplies like wheelchairs and walkers.

You’re eligible if: You or your spouse paid into Social Security for at least ten years through employment, you are a citizen or permanent resident of the United States, and you are aged 65 or older.

Your cost: Unlike Part A, which is free for most Medicare beneficiaries, you must elect and purchase Medicare Part B for a monthly premium. You may elect for your premium to be paid through your Social Security check or your Railroad Retirement benefit. Most people will pay the standard cost for Part B, but others may not. If your modified adjusted gross income noted on your IRS tax return two years ago is above a certain amount, you may pay a higher Part B monthly premium. This is called an Income Related Monthly Adjustment Amount (IRMAA). Likewise, if you do not elect Part B when you’re first eligible for Medicare Part A, you may be assessed a late enrollment penalty if you do not have a qualifying reason for not electing it during your Initial Enrollment Period (IEP).

The four parts of Medicare are labeled A, B, C, and D. Each part covers different health care costs:

Contact Social Security toll-free at 1-800-772-1213 (TTY: 1-800-325-0778) for more information about Medicare Part A and Part B premiums.

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Medicare isa federal program that provides health insurance for

those 65 and older, or younger individuals who qualify

under special circumstances (such as disability).

ORIGINAL MEDICARE consists of two parts — A and B.

Original Medicare may not cover all of your health care

needs (such as some dental and vision), so you have the

option to purchase additional coverage through a private

insurance company. The additional coverage consists of

Medicare parts C and D.

AH

B

CDRx

H

Part C : Medicare Advantage

Helps cover: The combined coverage of Medicare parts A and B, plus added benefits such as fitness programs, routine vision, hearing and dental care, and other wellness discounts. Plans may also include Medicare Part D Prescription Drug coverage. Medicare Advantage plans are offered by private insurance companies and are contracted by Medicare. If you join a Medicare Advantage plan, you still have Original Medicare. Your Part A and Part B coverage are administered by the Medicare Advantage Plan instead of Original Medicare.

You’re eligible if: You have both Part A and Part B, continue to pay the Medicare Part B premium, reside in the health plan’s service area, and do not have end-stage renal disease (ESRD) (exceptions apply).

Your cost: Your monthly premium is dependent on the Medicare Advantage plan you choose. Your Medicare Part B premium must also continue to be paid.

Choose the type of Medicare Advantage plan that works best for you:

• Health Maintenance Organization (HMO): HMOs use a network of doctors, hospitals, and other health care providers to offer you the most care at the lowest possible cost. You’ll have a primary care provider and use network providers in most cases with the use of a referral.

• Preferred Provider Organization (PPO): PPOs give members the ability to see any doctor they wish, when they wish. You may pay more to see a doctor outside the plan’s network.

• Point-of-Service (POS): A POS has combined characteristics of an HMO and a PPO plan, but offers you flexibility to see providers outside of the network. A referral may be required and your care may be coordinated through a primary care physician.

• Special Needs Plans (SNPs): These plans are for people with a chronic illness, older adults with limited incomes, and those living in nursing homes. Typically, you must have Medicare parts A and B as well as Medicaid to join a SNP plan.

Part D : Prescription Drug Plan (PDP)

Helps cover: Your costs for prescription drugs.

You’re eligible if: You are entitled to Medicare benefits under Part A or are enrolled in Part B and reside in the health plan’s service area, or have VA or TRICARE benefits.

Your cost: Depending on the plan you choose, you may have a monthly premium and other cost-sharing, like copayments and/or deductibles. You must also continue to pay your Medicare Part B premium.

Medicare Supplement Insurance Plans (Medigap)

You may have heard about another option to supplement your Original Medicare called a Medicare Supplement Insurance Plan (Medigap). These plans help with the costs you’re left with after Original Medicare (Parts A and B) pays its share.

Medigap plans are provided by a private insurer and do not include prescription drug coverage. While the monthly premiums are higher, some people choose a Medigap plan to reduce their deductibles, copayments, and coinsurance.

These plans are identified by the letters A through N, and each one has a distinct set of benefits.

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Now it’s time to see how the parts come together.

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Medicare Advantage plans conveniently combine Part A, Part B, and sometimes Part D, into one cohesive plan. Some perks of having a Medicare Advantage plan include: one bill to pay each month, dedicated customer service representatives, and added benefits like fitness and wellness programs.

Now you know how the parts of Medicare work, but how will it work for YOU? Let’s assess your needs.

The choice is yours.

ORBuild your coverage piece by piece: Choose an all-in-one Medicare Advantage Plan:

There are two ways to get your Medicare coverage:

1. 2.

Hospital Insurance

› Hospital stays › Skilled nursing care › Other services

Medicare Part A

Medical Insurance

› Doctor visits › Outpatient services › Other medical expenses

Medicare Part B

Medicare Advantage : Part C

› Part A and B benefits

› May include extras such as:• Vision• Hearing

› Your choice of:• HMO plan• PPO plan• Private Fee-for-Service plan

Available through a private insurance company, Medicare Advantage plans include:

May include prescription drug

coverage!

• Dental• Gym memberships

Prescription Drug Coverage

Medicare Part D

Medigap plans cover some or all of Medicare:

› Deductibles › Copayments › Coinsurance

Medicare Supplement

Purchase a Medicare Supplement

Purchase a Part D Prescription Drug Plan

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to beginWHERE

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Here

Have more questions?The Medicare Welcome Team is ready to answer them. Call today.

is where you can begin your Medicare journey. The following

questions can help you build a foundation for choosing coverage

that’s right for you and your retirement:

If YES ... If NO ...

Can I afford to pay the health care costs Original

Medicare doesn’t cover?

You will be responsible for:

• Part A and Part B deductibles

• A monthly premium for Part B

• 20% of the amount Medicare approves for the medical services it covers

• 100% of the cost for services not covered by Medicare

Consider joining a Medicare Advantage plan. Your premium could be as low as $0 a month and there are no deductibles. Costs are generally low and predictable, and could include prescription drug coverage. Another option is to stay with OriginalMedicare and purchase a Medicare Supplement Plan.

Do I live out of state for part of the year?

Choosing Original Medicare and purchasing a Medicare Supplement Plan is a good option, which would provide coverage anywhere in the United States.

A Medicare Advantage HMO, HMO-POS, or PPO plan may cover you for emergency or urgently needed care worldwide.

Do I want coverage for hearing aids, routine eye exams,

and dental services?

You may want to choose a Medicare Advantage plan that offers these additional benefits at no extra cost.

Consider staying with Original Medicare and purchasing a Medicare Supplement Plan.

Am I willing to get a referral to see a specialist?

Opt for a Medicare Advantage HMO plan. Your monthly premium could be as low as $0.

A Medicare Advantage PPO plan is a good option. You could also stay with OriginalMedicare and purchase a Medicare Supplement Plan.

Am I willing to pay more so that I can receive care

from any provider?

Consider a Medicare Advantage PPO plan or Medigap. You may have to pay more, but you’ll have the option to use doctors and hospitals outside the network.

A Medicare Advantage HMO plan will keep your costs down as long as you stay in network.

Ask yourself ...

to get startedWHEN

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Nowis the time to learn about your initial Medicare enrollment. Here’s what you need to know:

General Enrollment PeriodIf you didn’t sign up for Part A and/or Part B when you first became eligible, you can sign up between January 1 and March 31 each year. Your coverage will begin July 1 of that year.

Special Enrollment Period (SEP)You can make a change in your coverage when certain events happen in your life, like you move out of the plan’s service area, you enroll in Medicaid, or you start to receive Extra Help for your prescription drugs.

October 15 – December 7

Annual Election Period (AEP):• Anyone Medicare-eligible can join or

switch to a Medicare Advantage plan, Medigap policy, or Part D plan.

• Change from a plan that includes Part D to one that does not.

January 1 – February 14

Medicare Advantage Disenrollment Period (MADP):If you’re unhappy with your Medicare Advantage plan, you can disenroll. At this time, you can enroll in Original Medicare, Medicare Part D, and Medigap. Your benefits will begin on the first day of the next month.

Initial Enrollment PeriodYou have a seven-month window to enroll in Medicare. This includes three months before you turn 65, the month of your birthday, and ends three months after the month you turn 65.

If you sign up prior to your birthday, in most cases, your coverage starts the first day of the month of your birthday. However, if your birthday is on the first of the month, your coverage will start the first day of the month before your birthday.

Missing your Initial Enrollment Period (IEP) can be costly. Medicare Part A, Part B, and Part D all may charge late enrollment penalties if you delay and miss your initial dates to enroll. These penalties will be added to your monthly premium for the duration of your Medicare membership.

If you want to sign up for a Medicare Advantage plan (Part C), you can do so during your seven-month IEP. If you want to sign up after your IEP, you’ll have to wait until the Annual Election Period (AEP) unless you qualify for a Special Enrollment Period, or the General Enrollment Period.

Helpful Tip:

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Rx

PART A

PART B

PART C

PART D

Your 65th birthday

BEFORE

Months Months

AFTER

Important dates to

remember:

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Your coverage options will change depending on whether you’re retired, or still working. Read through these different scenarios and see which one best applies to you.

Are you currently enrolled in Medicare?• Review your coverage and budget, regularly.• Review Medicare plan options in your area.

Are you eligible for Medicare and still working?• If you are still working and have employer-provided

coverage, you should contact your Benefits Administrator to determine if you need to enroll in Medicare Part A or Part B. In certain circumstances, your benefits plan may require you to pay for what Original Medicare would cover if you fail to enroll when you’re first eligible.

• If you are not covered at work, review Medicare plan choices in your area.

Are you eligible for Medicare and not working?• Review Medicare plan choices in your area.• If you’d like to cover family members who are not

eligible for Medicare, explore the individual health plans in your area.

• Don’t wait to choose a plan. You could face penalties if you miss your enrollment deadline.

Are you currently enrolled in an individual Qualified HealthPlan (QHP) through a health insurance carrier or Marketplace?

• Enroll in Medicare Parts A and B as soon as you are eligible for Medicare.

• You may want to drop your QHP coverage—notify your plan at least 14 days before you want your coverage to end.

• After enrolling in Original Medicare, consider whether you would like the added coverage that comes with a Medicare Advantage or Medicare Supplement plan.

• You need to be aware of your Initial Enrollment Period and take steps to enroll during that period to avoid any late enrollment penalties.

Are you eligible for Medicare and retiring soon or losing health insurance coverage?

• Talk with your benefits administrator to find out how Medicare might work with your possible retiree benefits.

• If retiree coverage isn’t available to you, review the Medicare plan choices in your area.

• If your family is currently on your employer-sponsored plan and not yet eligible for Medicare, advise them to consider COBRA or an individual plan.

• Don’t delay signing up for Medicare Part B if you are on COBRA, because you could face a possible penalty and a possible gap in coverage. COBRA may end once you sign up for Medicare; However, you will be eligible to purchase COBRA if you enroll in Medicare first.

• Remember—there is a limited amount of time to sign up without being penalized.

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Take into consideration the information above as you learn about enrollment in the next section.

to enrollHOW

1918

It’s easyto enroll — and we can help! The enrollment process will differ

depending on what type of Medicare plan you choose.

Enrolling In Original Medicare (Parts A and B)If you’re receiving Social Security benefits, you’ll be automatically enrolled in Medicare. If you’re not, you’ll need to sign up for Medicare yourself with the Social Security Administration. You can:

• Enroll by phone or online with the Social Security Administration.

• Visit the Social Security office nearest you and enroll in person. (Take an original or a certified copy of your birth certificate, W-2 forms for the past two years, and your Social Security card or number.)

You do NOT have to be retired to enroll in Original Medicare. If you’re still working and have employer-provided coverage, Medicare will be the primary payer for Part A hospital services, but you can delay Part B enrollment without a penalty until you lose your employer coverage.

Enrolling In Medicare Part BIf you want to delay Part B enrollment, you must decline Part B enrollment during the Initial Enrollment Period (see “WHEN” tab for dates) and return your Part B notice to Social Security.

If you are 65 and have COBRA coverage on an employer’s policy, you should enroll in Part B. You must sign up for Part B during the first eight months you have COBRA to avoid the late-enrollment penalty in the General Enrollment Period.

If you’re turning 65 and have a Qualified Health Plan (QHP) that you purchased on your own through the Healthcare Exchange or Marketplace, you need to enroll in Medicare Part B during your Initial Enrollment Period. You must notify your current provider that you are moving off that plan.

Enrolling In Medicare Part C (Medicare Advantage)You can join a Medicare Advantage plan as soon as you become eligible for Medicare parts A and B, during your Initial Enrollment Period. But you’ll need to be enrolled in Part A and Part B before joining. If you don’t join a Medicare Advantage plan during your Initial Enrollment Period, you can join during the Annual Election Period.

Each private insurance company that offers a Medicare Advantage plan handles the enrollment process. The Independence Blue Cross Medicare Welcome Team is here to help you with any questions you might have:

Enrolling In Medicare Part D Prescription Drug PlanIf you’re entitled to Medicare Part A or enrolled in Part B, you can join Part D during your Initial Enrollment Period. If you miss your Initial Enrollment Period, you will have to wait until the Annual Election Period. Each private insurance company that offers Part D handles the enrollment process.

Helpful Tip: If you enroll in a Medicare Advantage plan that includes a Part D drug plan (even if you don’t take the coverage), you cannot also enroll in a stand-alone Part D plan. You must have your medical and prescription drug coverage from the same insurance plan unless you have VA or TRICARE benefits.

Visit www.ibxmedicare.com/guide

Call 1-866-447-9281 (TTY/TDD: 711)7 days a week, 8 a.m. to 8 p.m.

Easy Reference Number: KDG4G3

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Rx

choose IBX?WHY

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75 yearsof experience with area residents, doctors, and hospitals make us one of the leading health insurance organizations in the Philadelphia area. And with several plans to choose from, it’s easy to find one that works for you.

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Questions? The Medicare Welcome Team is here to help. Call, click, or meet with us today:

PHONE To request information by mail, call toll-free

1-866-447-9281 (TTY/TDD: 711)7 days a week, 8 a.m. to 8 p.m.

MEETING Join us at an informational meeting. Call or go online for dates and times.

AT HOME We can arrange an in-home visit at your convenience. Let us know when you call.

WEB Visit www.ibxmedicare.com/guide for more information.

Connect with us on Facebook: www.facebook.com/ibxmedicare

Easy Reference Number: KDG4G3

Keystone 65 HMO• If you’re looking for affordability, Keystone 65 HMO may be

the right choice for you. Our plans have low premiums, low deductibles, membership in fitness programs, and much more!

Personal Choice 65SM PPO• Want more provider choices? Personal Choice 65 PPO may be

the plan for you. You’ll have the freedom to use your choice of doctors and hospitals, and no referral is required.

MedigapSecurity• For more flexibility, supplement your Original Medicare

insurance with private health plan coverage. Options include plans with wellness programs, coverage when you travel in the United States and emergency coverage outside of the United States.

These plans are backed by the stability and experience of Independence Blue Cross, an organization that has been a Philadelphia-area health care leader for nearly 80 years. Our commitment to providing products of value extends to almost 160,000 local residents on Medicare. As a member of the Independence Blue Cross family, you can count on us to be here when you need us — for benefits you can depend on, service you can rely on, and the peace of mind that comes from being covered by a local health insurance organization with a national reputation.

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FAQs

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Here aresome of our most frequently asked questions.

Do I receive a notice about Medicare when I turn 65?If you are already receiving Social Security benefits, you will get information about Medicare in the mail three months before you turn 65. If you are not receiving Social Security benefits, you must actively enroll in Medicare yourself by contacting your local Social Security office. See the back of this guide for contact information.

Will I face a penalty if I wait to enroll in Medicare Part D?Yes. You will have to pay an additional Late Enrollment Penalty if, at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage. Before your initial enrollment period begins, check with your benefits administrator or QHP to determine if your current prescription drug coverage is considered creditable coverage.

Will money be taken out of my Social Security check for Medicare?Part A is free for most people. You only have to pay a premium for Part A if you or your spouse have not worked and contributed to Social Security for 40 work quarters (10 years). Most people pay a monthly premium for Part B. You can either write a check to Social Security or have the Part B premium automatically taken out of your Social Security check or Railroad Retirement Benefit.

My income is low. Are there programs that can help me afford my Medicare premiums?Yes. Every state has Medicare Savings Programs (MSPs) that can help pay your Part B premium. A Medicare Savings Program may also pay Medicare copays and deductibles. You can also see if you are eligible for Extra Help. Extra Help is a federal program that can help pay your Part D prescription drug costs. Contact us to receive our Guide to Savings which outlines a lot of programs available and their criteria for enrollment.

I’m 63 and I just lost my job. Can I get Medicare early?Unlike Social Security retirement benefits, you cannot enroll in Medicare early. Unless you have been receiving Social Security Disability Insurance benefits (SSDI) for 24 months or have ESRD or ALS, you must wait until you are 65 to receive Medicare.

If I have Medicare, do I need to get coverage from the new health care exchanges or Marketplace?No. You do not need to use the health care exchanges. If you have Medicare, you are insured and you will not face penalties under the provisions of the Affordable Care Act.

I have a Qualified Health Plan (QHP) that I purchased through the Marketplace. Can I keep this coverage after I enroll in Medicare ?You can keep your QHP coverage, but it may be a costly choice. If you keep your plan after enrolling in Original Medicare, you may not qualify for any tax credits to help pay for your plan’s monthly premium, which will make it much more expensive. There’s also no guarantee that your plan will pay anything toward your health or drug claims after Medicare pays, so you may be paying a high premium for little to no coverage.

It makes more sense to look into your Medicare choices like Original Medicare with a stand-alone Part D plan and a Medigap policy or a Medicare Advantage plan. These Medicare coverage options may be more comprehensive and have lower costs than keeping your QHP.

Where can I get help in choosing coverage?There are government-supported resources that you can visit, including Medicare.gov, which provides information about plans. You can also contact Independence Blue Cross to speak with a representative from the Medicare Welcome Team. We will gladly walk you through your decisions and help you determine if a Medicare Advantage plan is right for you.

I’m turning 65 this year, but I will not be retiring at this point. If I wait until retirement to enroll in Medicare Part B, will I be penalized?If you are still working and have employer-provided coverage, you should contact your Benefits Administrator to determine if you need to enroll in Medicare Part A or Part B. In certain circumstances, your benefits plan may require you to pay for what Original Medicare would cover if you fail to enroll when you’re first eligible. If you are not covered at work, review Medicare plan choices in your area.

Visit www.ibxmedicare.com/guide for more information.

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You must continue to pay your Part B premium.This information is not a complete description of benefits. Contact the plan for more information.Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. Independence Blue Cross offers Medicare Advantage plans with a Medicare contract. Enrollment in Independence Medicare Advantage plans depends on contract renewal.Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association. MedigapSecurity plans are offered through Independence Blue Cross and Highmark Blue Shield, independent licensees of the Blue Cross and Blue Shield Association. MedigapSecurity is not connected with or endorsed by the U.S. government or the federal Medicare program. To join, you must be enrolled in Medicare Parts A and B. Plan F and Plan N are available only to applicants who enroll within six months following enrollment in Medicare Part B or who are guaranteed the right to purchase these plans under applicable federal or state laws. You must continue to pay Medicare Part A (if applicable) and Part B premiums. A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings, call 1-866-447-9281 (TTY/TDD: 711).

Easy Reference Number: KDG4G3

©2016 Independence Blue Cross 6645(05/16)BRO

Centers for Medicare & Medicaid Services1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048)www.medicare.govAvailable 24 hours a day, seven days a week.

Social Security Administration1-800-772-1213 (TTY: 1-800-325-0778)www.ssa.govCall or go online 24 hours a day, seven days a week. You can speak directly with a representative Monday through Friday from 7 a.m. to 7 p.m.

Independence Blue Cross1-866-447-9281 (TTY/TDD: 711)www.ibxmedicare.com/guide7 days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from February 15 - September 30, your call may be sent to voicemail.

Important Phone Numbers

Medicare Welcome Team

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