What Medicare Plans Does Blue Cross Blue Shield of Georgia Offer?
This article was updated on: 10/20/2018
If you are already enrolled in Medicare or approaching eligibility, you may be interested in learning about some of your coverage options beyond Original Medicare, Part A and Part B. Blue Cross Blue Shield of Georgia has a variety of offerings, including Medicare Advantage plans, Medicare Supplement (Medigap) plans, and stand-alone Medicare Part D Prescription Drug Plans.
Medicare Supplement and stand-alone Medicare Prescription Drug Plans work alongside Original Medicare, while Medicare Advantage plans let you get your Part A and Part B coverage in a different way and may include extra benefits. Depending on where you live in the state, you may be eligible to enroll in one of these types of plans offered by Blue Cross Blue Shield of Georgia.
Here’s an overview of each of these types of coverage and how they work.
Does Blue Cross Blue Shield of Georgia offer Medicare Advantage plans?
When you first become eligible for Medicare, in most cases you’re enrolled in Original Medicare, Part A and Part B, which is the federally administered health-care program. However, Medicare Advantage (Part C) is another way to get those same Part A and Part B benefits; the main difference is that instead of having your benefits administered by the government program, you’ll get them through your Medicare Advantage plan (such as an HMO or PPO).
Medicare-contracted private insurance companies like Blue Cross Blue Shield of Georgia must include at least the same level of coverage available under Original Medicare (Part A and Part B) in their Medicare Advantage plans. Hospice care, however, is still covered under Part A. These plans may also offer extra benefits, such as prescription drug coverage, wellness programs, and coverage for routine vision and dental care. Under Original Medicare, these benefits aren’t covered (although prescription drug coverage is available through a separate Medicare Prescription Drug Plan).
Many Medicare Advantage plans offered by Blue Cross Blue Shield of Georgia include prescription drug coverage. These plans are also known as Medicare Advantage Prescription Drug plans. Depending on the plan you choose, you may also be eligible for routine vision or dental benefits, and coverage of the SilverSneakers fitness program, as well.
You must continue to pay your Part B premium with a Medicare Advantage plan, plus any premium due for your specific plan, if applicable. You may also be responsible for copayments, coinsurance, and/or deductibles when you access benefits. Not all plans may be available in all areas of the state, and plan benefits and premiums may vary.
Blue Cross Blue Shield of Georgia offers several different types of Medicare Advantage plans. Depending on your specific zip code and service area, here are some of the plan types that may be available to you:
- MediBlue Health Maintenance Organization (HMO) plans: Blue Cross Blue Shield of Georgia offers several types of HMO plans, which typically require you to use network providers for all your care. The exception is medically necessary emergency or urgent care services, which you’ll still be covered for even if you go out of network. A primary care physician (PCP) will manage most of your care, and you’ll need to get a referral from your PCP if you need to see a specialist. Some plans may be available at no additional monthly premium; however, keep in mind that even if a Medicare Advantage HMO plan has a $0 monthly premium, there may be other plan costs (such as copayments, coinsurance, and deductibles).
- MediBlue Preferred Provider Organization (PPO) plans: These plans give you the flexibility to choose your health-care providers, but you may save money by using in-network preferred providers. Many plans include the SilverSneakers fitness program. You don’t need referrals for this type of plan.**
- MediBlue Dual Advantage HMO-SNP (Special Needs Plan): These plans limit enrollment to people who also qualify for both Medicare and Medicaid coverage; live in an institution or need nursing-level care at home; or have certain chronic or disabling health conditions (such as diabetes or HIV). You’ll need to meet the eligibility criteria of the plan to enroll, and not every type of plan may be available where you live.
Keep in mind that any of the above plan types may include prescription drug coverage (and Special Needs Plans must always include it). However, not every plan may include it, so check with the specific Medicare Advantage plan before enrolling to make sure Part D coverage is included if you want this benefit.
Does Blue Cross Blue Shield of Georgia offer Medicare Part D Prescription Drug Plans?
You may be eligible to enroll in a stand-alone Medicare Part D Prescription Drug Plan from Blue Cross Blue Shield (BCBS) of Georgia if you have Part A and/or Part B and live in the plan’s service area. Under Original Medicare, your prescription drug benefits are limited to medications you get during a hospital or skilled nursing facility stay, or certain outpatient prescription drugs. For all other prescription drug coverage, however, you’ll need to enroll in a Medicare Prescription Drug Plan if you want help with your medication costs.
Each Medicare plan with prescription drug coverage uses a tiered formulary (list of covered medications) to determine coverage. Plans organize covered medications into “cost tiers,” with different copayments and coinsurance costs for the prescription drugs on each tier. You’ll typically pay less for medications on the lower tiers, usually preferred generic medications, and more for higher-tiered drugs, which may include brand-name and specialty medications. All of BCBS of Georgia Part D plans feature a Select Care Drugs Tier 6 that includes medications to treat common medical conditions for seniors for hypertension, diabetes, high cholesterol and osteoporosis at a $0 copay with a $0 deductible at preferred network pharmacies. Two of these plans also offer a $0 copay for Tier 6 medications during Medicare’s coverage gap benefit phase.
You may have copayments, coinsurance, and/or deductibles depending on the plan you choose. Plans typically change their formularies at the beginning of a benefit year, but may change coverage or edit for certain specific reasons defined by Medicare. They will notify you in writing when necessary.
Does Blue Cross Blue Shield of Georgia offer Medicare Supplement insurance (Medigap)?
Medicare Supplement (Medigap) Plans A, F, G, and N may be available to help with certain out-of-pocket costs that Original Medicare doesn’t cover. Depending on the plan, you may be able to get help with expenses like deductibles, copayments and/or coinsurance, and emergency health care when you’re traveling out of the country. These plans only work with Original Medicare and can’t be used to pay for plan costs you may have if you’re enrolled in a Medicare Advantage plan.
There are up to 10 plans available in most states, including Georgia, with each plan type labeled with a letter A through N (for example, Plan F). BCBS of Georgia offers Medicare Supplement Plans A, F, G, and N. Benefits for Medigap plans are standardized across plans of the same letter type. Depending on where you live, you may be eligible to enroll in a Medigap plan from Blue Cross Blue Shield of Georgia if you’re currently enrolled in Original Medicare, Part A and Part B. Not all plans may be available in all areas and your plan premium may vary depending on where you live.
As you can probably tell, you may have a variety of Medicare plan options available in your zip code, including plans from BCBS of Georgia. Would you like to learn more about types of coverage that may work for you? To start comparing plan options in your service area right now, just click the Find Plans button on this page.
**Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.