FAQs
There's a lot to learn about Medicare and your options. The following includes many commonly asked questions about Medicare, supplemental Medicare coverage (Medigap), and Medicare Part D prescription plans.
Don't see what you're looking for? If you're already a member of one of our health plans, just call Member Service at the number shown on the front of your ID card.
Not a member and still have questions? Just Contact Us. We'll be happy to answer any questions you may have about our Medicare Advantage, supplemental insurance, and Medicare Part D plans.
- What is Original Medicare?
- What is Medicare Part D?
- How does Medicare Part D work?
- Who is eligible for Medicare Part D prescription coverage?
- When can I enroll in a plan or change plans?
- Will my doctor accept my coverage?
- How do I know if I should sign up for Part D?
- What are the advantages to Medicare Part D?
- Do I have to participate in a Part D plan?
- Why is there a late-enrollment penalty?
- Can I switch Part D plans once I have enrolled?
- Is Part D coverage only available through a private company, or will I be able to get coverage directly from Medicare, the same way that I get Part A and Part B coverage?
- What is creditable coverage?
- I have prescription coverage through the Veterans' Administration (VA). Can I continue to get my medications through the VA?
- What if I receive health care coverage through a former employer?
- I understand that financial assistance may be available. How do I find out if I qualify for help?
- What if I believe I qualified for extra help and believe I'm paying the wrong prescription copayment?
- Can premiums be deducted from Social Security checks?
What is Original Medicare?
Original Medicare is a federally funded health insurance plan. It is designed for people age 65 or older and some disabled people under age 65. Medicare Part A pays for inpatient hospital care, skilled nursing facility care, and hospice care. Medicare Part B pays for outpatient hospital care, doctor visits, and many other medical services not covered by Part A.
With Original Medicare, you get easy access to care.
- You can use any doctor or hospital that accepts Medicare (and most do)
- Original Medicare doesn't require you to select a primary care physician (PCP) or get a referral to seek care from a specialist
What is Medicare Part D?
Medicare Part D is a benefit designed to help those eligible for Medicare pay for the cost of prescriptions. With Part D, Medicare shares the cost of the prescription benefit with those eligible.
How does Medicare Part D work?
Medicare offers the Part D benefit by contracting with private companies, also referred to as prescription drug plans (PDPs) or Medicare advantage prescription drug plans (MA-PDs). People with Medicare can purchase the Part D benefit from a Medicare-approved PDP located in the geographic area where they live.
Who is eligible for Medicare Part D prescription coverage?
All individuals eligible for Medicare Part A and/or enrolled in Medicare Part B are eligible to enroll regardless of age, income, or health conditions.
When can I enroll in a plan or change plans?
You may join or leave a plan only at certain times. For example, each year you will be able to choose a different Medicare Part D prescription or Medicare Advantage plan during an annual election period. If you are eligible for both Medicare and Medicaid, you may change plans at any time.
The annual election period for Medicare Part D and Medicare Advantage plans is typically November 15 through December 31 of each year.
The open enrollment period for Medicare Advantage plans is typically January through March, annually. However, there are limitations on the kind of plans in which you can enroll. For more information, contact Member Service at 1-800-200-4255 (TTY: 1-800-522-1254), Monday through Friday, 8:00 a.m. to 8:00 p.m. ET
Will my doctor accept my coverage?
Visit Find a Doctor and search for your provider(s) to find out if they will accept your coverage.
How do I know if I should sign up for Part D?
You will need to review your options carefully to see if a Part D plan is right for you. Part D plans are designed to provide financial savings to most people with Medicare. As insurance plans, they provide protection against future, unexpected costs. They also provide additional financial assistance for people with lower incomes.
What are the advantages to Medicare Part D?
A Medicare Part D plan can offer you:
- access to an extensive pharmacy network (including independent pharmacies and national chains)
- competitive discounts
- point-of-sale claim processing
- a mail service prescription purchase option
- medical therapy management programs
Do I have to participate in a Part D plan?
It's your choice—you are not required to enroll in a Part D plan. However, if you decide to participate after your initial enrollment period, you may have to pay a federally mandated late enrollment penalty.
Why is there a late-enrollment penalty?
Congress believes that unless you already have creditable prescription coverage, Part D plans are a great way for you to get help with the cost of prescriptions. They created rules to encourage people to enroll when they become eligible, instead of waiting to join only when health problems develop and prescription costs rise. The late enrollment penalty gives people a reason not to postpone their decision.
Can I switch Part D plans once I have enrolled?
You may join or leave a plan only at certain times. For example, once enrolled in a Part D plan, you may choose a different Part D prescription or Medicare Advantage plan with Part D coverage during the annual election period, which is typically November 15 through December 31 of each year.
The open enrollment period for Medicare Advantage plans is held annually January 1 through March 31. However, there are limitations on the kind of plans in which you can enroll. For more information, contact Member Service at 1-800-200-4255 (TTY: 1-800-522-1254), Monday through Friday, 8:00 a.m. to 8:00 p.m. ET
If you are covered by your former employer, contact your benefit administrator to find out when you can enroll or change your current plan.
Is Part D coverage only available through a private company, or will I be able to get coverage directly from Medicare, the same way that I get Part A and Part B coverage?
Part D coverage is not available directly from Medicare. You must purchase Part D coverage from a private company that has been approved by Medicare to offer coverage, such as Blue Cross Blue Shield of Massachusetts.
What is creditable coverage?
Creditable coverage is coverage from a plan other than a Part D plan that meets certain Medicare standards. If you currently have prescription coverage that is considered creditable coverage, you may keep that coverage and wait to enroll in a Part D plan. If you later decide to enroll in a Part D plan, you will not have to pay a penalty.
I have prescription coverage through the Veterans' Administration (VA). Can I continue to get my medications through the VA?
Part D benefits have no impact on Veterans' Administration benefits. People with Medicare who currently have prescription benefits through the VA will be able to continue to obtain their prescriptions through the VA.
What if I receive health care coverage through a former employer?
Some employers have tailored benefits for their retired employees. Benefits that vary among employer groups include prescription drug coverage, podiatry, and chiropractic services, among others. For more information about your specific plan benefits, contact your former employer's benefits administrator.
I understand that financial assistance may be available. How do I find out if I qualify for help?
If you have both Medicare and Medicaid, you already qualify for low-income assistance. If you don't qualify for Medicaid, you may still qualify for some assistance. If you're a Massachusetts resident, contact the Prescription Advantage Program at 1-800-AGE-INFO (1-800-243-4636), (TTY: 1-877-610-0241), Monday through Friday, 9 a.m. to 5 p.m. ET.
If you aren't getting extra help, you can see if you can qualify by calling:
- 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048) 24 hours a day/seven days a week
- The Massachusetts Department of Elder Affair's SHINE program office at 1-800-AGE-INFO (243-4636)
- The Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778) Monday through Friday, 7:00 a.m. to 7:00 p.m. ET
What if I believe I qualified for extra help and believe I'm paying the wrong prescription copayment?
If you believe you qualified for extra help and that you are paying an incorrect copayment amount when you get your prescription at a pharmacy, Blue Cross Blue Shield of Massachusetts has established a process that will allow you to either request assistance in obtaining evidence of your proper copayment level, or, if you already have the evidence, to provide this evidence to us. This is known as the Best Available Evidence Policy.
Please contact Member Services for a complete list of acceptable forms of evidence or view the CMS Best Available Evidence Policy.
When we receive the evidence showing your copayment level, we will update our system or implement other procedures so that you can pay the correct copayment when you get your next prescription at the pharmacy. Please be assured that if you overpay your co-payment, we will reimburse you. Either we will forward a check to you in the amount of your overpayment or we will offset future copayments. Of course, if the pharmacy hasn't collected a copayment from you and is carrying your copayment as a debt owed by you, we may make the payment directly to the pharmacy. If a state paid on your behalf, we may make payment directly to the state.
Can premiums be deducted from Social Security checks?
Yes, you may have the option to have the premium deducted from your Social Security check (just like your Part B premium).
