Medicare Options from Your Michigan Employer

There are four parts of Medicare. Each one helps pay for different health care costs.

Parts A and B

This is what's called Original Medicare. It helps pay for hospital and facility costs, including hospice care and home health care. It also helps pay for medical costs outside a hospital, including doctor visits and preventive care.

Part C

This is called Medicare Advantage. It covers everything Original Medicare does, but it also puts a limit on your out-of-pocket costs. Some of these plans also cover preventive dental, vision and hearing costs. They're only available through private health insurance companies, like Blue Cross.

Part D

This plan type helps pay for prescription drugs. It covers commonly used brand-name and generic drugs. Some plans cover more drugs than others. These plans are also only available through private health insurance companies.

Medicare supplement plans don't work like most health insurance plans. They don't actually cover any health benefits. Instead, these plans cover the costs you're responsible for with Original Medicare. 

These costs can include:

• Your Medicare deductibles 
• Your coinsurance 
• Hospital costs after you run out of Medicare-covered days 
• Skilled nursing facility costs after you run out of Medicare-covered days

Medicare supplement plans don't include Part D prescription drug coverage. So if you're thinking about buying one of these plans, you'll want to make sure you buy a separate Part D plan.

A Medicare supplement plan might be a good choice for you if you already have prescription coverage through an employer or military benefits.

These terms all describe money you pay toward health care when you have a health insurance plan.

Copays and coinsurance

A copay is a fixed amount of money you pay for a certain service. Your health insurance plan pays the rest of the cost.

Coinsurance refers to percentages.

Our Medicare Advantage plans use copays for most services.

You pay 20 percent coinsurance for most services with Original Medicare. 

Deductible

A deductible is the amount of money you pay for care before your plan starts paying. For most services, you'll pay the full cost until you reach the deductible. After you reach your deductible, you’ll still have to pay any copays or coinsurance.

Most Medicare Advantage plans have separate medical and pharmacy deductibles. Original Medicare has its own deductibles, but if you have a Medicare Advantage plan, you don't have to worry about them. We pay the Original Medicare deductibles for you.

How they all work together

When you have a Blue Cross plan, we track all the costs you pay – deductible, copays and coinsurance. When you reach a certain amount, we pay for most covered services. This is called the out-of-pocket maximum.

Original Medicare doesn’t have an out-of-pocket maximum. There's no cap on what you pay out of pocket. And if you're in the hospital or a skilled nursing facility, Original Medicare only pays for a certain number of days. After that point, you pay the full amount each day.

For Medicare Advantage members, the cost of COVID-19 vaccines and their administration is covered at 100% in-network. COVID-19 tests and medical treatments are subject to a member’s normal copays, coinsurance and deductibles as indicated in their current year benefit packages.