Medicare Information

 

The ABCDs of Medicare

Highmark Direct is dedicated to helping you find the Medicare coverage that fits your needs. To evaluate your plan options, it's important to understand how the different parts of Medicare work.  Click on the questions below to reveal answers to your frequently asked questions.

To understand more about your Medicare plan options, schedule an appointment to talk with one of Highmark Direct's licensed associates or view upcoming Medicare Solutions Seminar in your area.

 

 

Medicare Basics

Who is Medicare eligible?

You are Medicare eligible if: 

  • You’re 65 years or older or have a disability 
  • You’re a U.S. Citizen or a legal U.S. resident for 5 consecutive years 

What is Original Medicare?

Medicare Parts A & B—also known as Original Medicare— only cover 80% of medical costs, leaving you to pay the rest out-of-pocket. Keep in mind that many common benefits, including prescription drugs, are not covered by Parts A & B.

What is not included in Original Medicare?

The U.S. Government provides Original Medicare, which only covers a portion of health care costs. Here is a list of common health care services not covered by Original Medicare.

·         Eye exams and glasses

·         Prescription drugs

·         Routine dental care

·         Long-term care

·         Non-emergency care

·         Hearing aids exams and fittings

What is Medicare Part A?

Part A coverage—also known as hospital insurance— is provided by the U.S. government to cover any medical care that requires an overnight hospital stay. It also helps pay for follow-up nursing care after a hospital stay, hospice care and some at-home care. Part A also covers annual checkups and many preventive services without requiring co-payments. Most people are automatically enrolled in Part A and there is no monthly premium.

What is Medicare Part B?

Part B covers some preventive services to help when you’re sick. With Health Care Reform, Part B now also covers services such as annual wellness exams, doctor visits and outpatient care. Here is a full list of services available in Part B:

·         Doctor visits

·         Other health care provider visits

·         Annual wellness exams

·         Outpatient care

·         Durable medical equipment (DME)

·         Lab tests, X-rays and blood work

·         Wheelchairs and walkers

·         Ambulance services

·         Mammograms

·         Prostate cancer screenings

·         Heart disease and diabetes screenings

·         Outpatient physical therapy

·         Mental health care

 

Enrolling in Part B is your choice and typically has a monthly premium that is deducted from your Social Security check. 

What is Medicare Part C (Medicare Advantage)?

Original Medicare only covers 80% of your medical costs, leaving you to pay the rest out-of-pocket. But Medicare Advantage plans give you the protection you need to cover a broad range of health care needs. These plans combine with Original Medicare (Parts A and B) to offer even more benefits, such as vision, dental, hearing and prescription drug coverage. Offered by private insurance companies, these plans cover costs Original Medicare doesn’t, and come in two main plan types:

  • HMO plans tend to have a narrower network of providers, but offer cost savings.
  • PPO plans have a wider network, but may have higher premiums or out-of-pocket costs.

 

Whichever plan type you choose, you always have access to emergency and urgent care coverage no matter where you are. For information about Highmark Medicare Advantage plans, call 1-866-456-2890 (TTY/TDD users may call 711), 8 a.m.-8 p.m., seven days a week.

What “extras” do I receive with Medicare Advantage?

In addition to traditional health insurance offerings, Medicare Advantage plans give you great extra benefits like coverage for:

·         Vision Care Eyeglasses or contact lenses

·         Hearing Aids

·         Dental and Dentures A select amount of coverage each year

·         Chiropractic and Podiatry A select number of routine visits each year

·         Prescription Drugs Built-in coverage for Medicare-approved Part D drugs

·         Fitness Programs Membership at participating gyms

What is Medicare Part D?

Part D is prescription drug coverage provided by private insurance companies. If you take prescription drugs, it’s very important to know whether your medications are covered by the plan you choose. Medicare Advantage plans may include Part D coverage, otherwise you can sign up for stand-alone plans if you already have Medicare Parts A and B. Be sure to check the plan’s coverage list or formulary.

 

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Highmark is a registered mark of Highmark Inc. Highmark Choice Company, Highmark Senior Health Company and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company and HM Health Insurance Company depends on contract renewal. Highmark Senior Health Company, Highmark Choice Company, Highmark Senior Solutions Company and HM Health Insurance Company are independent licensees of the Blue Cross and Blue Shield Association.