Blue Cross and Blue Shield of North Carolina®
North Carolina Medicare Supplemental FAQ
1. What is Medicare?
A: Medicare is a Federal health insurance
program for people ages 65 years or older, certain people with disabilities,
and people with permanent kidney failure treated with dialysis or a transplant.
Medicare has two parts - Part A, which is hospital insurance and Part B, which
is medical insurance.
2. What is a Medicare Supplemental plan?
A: Medicare Supplement insurance policies
are sometimes called Medigap plans. Medigap plans are private health insurance
policies that cover some of the costs the original Medicare plan does not cover.
Some Medigap policies will cover services not covered by Medicare, such as prescription
drugs. Medigap has 10 standard plans called Plan A through J, and 2 high deductible
plans called Plan H Prime and J Prime. BCBSNC® offers Plans A through Plan F
and Plan H through Plan J.
3. Why do I need a Medicare Supplemental plan?
A: Medicare does not pay for all of your health
care bills. Supplemental plans are designed to pay many of those extra expenses
not covered by Medicare alone, such as deductibles and copayments.
4. Will I have a waiting period for any pre-existing
conditions?
A: Pre-existing conditions are conditions
for which medical advice was given or treatment was recommended by or received
from a doctor within six months of the effective date of coverage. The six month
waiting period will be reduced by the amount of time you have spent under other
health insurance coverage as long as the coverage is terminated no more than
63 days prior to your effective date. The six month waiting period is also waived
if you apply within six months of your Medicare Part B enrollment date.
5. Do I have to answer health questions to qualify
for a Medicare Supplemental plan?
A: No, if you apply within six months of your
Medicare Part B effective date. Yes, if you apply six months past your Medicare
Part B effective date.
6. Will my rates increase because I get older?
A: No, if you receive an increase in the future,
it will be due to health care cost increases and changes in Medicare. You will
never be singled out for a rate increase.
7. What action should I take when I receive an explanation
of benefits statement?
A: The explanation of benefits statement is
not a bill. It is a notification that your claim has been processed and indicates
any amounts paid, denied or owed by you to providers of care.
8. What does the "Your Balance" field mean
on the explanation of benefits statement?
A: This is the amount you are responsible
to pay to the provider of care.
9. Does the "Your Balance" field include
prior payments (made by subscriber or Medicare)?
A: No. The "Your Balance" field
indicates our calculation of your liability. Any amounts paid by you or Medicare
are not reflected in the calculation.
10. Where can I get more information regarding Medicare?
A: Please visit http://www.medicare.gov/
If your plan covers prescription drugs...
11. How can I make sure my pharmacy is participating?
A: Most large retail pharmacy chains participate,
however, check with your pharmacy or call the toll-free number listed on your
identification card before purchasing your prescription drugs.
12. Do I need to submit paper claims?
A: No. Your participating pharmacy will submit
your prescription drug claims for you.
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