At Anthem Blue Cross and Blue Shield we know that Medicare is a complicated topic, and choosing the right Medicare plan isn't easy. Before your Anthem Blue Cross and Blue Shield representative reviews our benefits we would like to go over some important information. So we can assist you with your personal needs.
Please complete the permission form, if you are meeting with a representative individually please ensure you have completed the scope of appointment form which authorizes us to talk to you about our plans. We have pre-enrollment kits available with our hours of operation, website, customer service number, the multi-language interpreter service, insert our Medicare star rating, and more information, Anthem Blue Cross and Blue Shield is a Medicare Advantage organization with many different types of plans. Please talk with your sales representative to see which plans are offered in your area, not all plan types are available in all service areas.
Original Medicare coverage can consist of up to 3 Parts. Part A covers hospital costs, Part B is for physicians and laboratory costs, and you can add Part D for prescription drugs, Part C also known as Medicare Advantage, combines the parts into one plan like most Anthem Blue Cross and Blue Shield plans.
All Medicare Advantage plans have an annual contract with Medicare, to join a Medicare Advantage plan you must have Part A and B live in the plans surface area and not have end-stage renal disease, unless your service area has an end-stage renal disease plan Anthem Blue Cross and Blue Shield may also have several special needs plans, depending on your service area, ask your representative which plans are available in your neighborhood.
Annual enrollment period or AEP is from October 15th to December 7th, anyone can join a plan at that time if you're in a plan you have the option to return to Original Medicare and join a Part D plan during the annual dis-enrollment period.
From January 1st to February 14th you can join our plan outside of the annual enrollment period, if you qualify for a special election period, for example, if you have both Medicare and Medicaid, if you qualify for a special needs plan, if you lose your Medicaid institutional status or become ineligible for a special needs plan, you will be disenrolled from your plan and have a special election period.
When you turn 65 your election period begins three months before your birthday, and three months after that is considered your initial enrollment period. There are many other ways you can qualify for a special election period, and we can discuss that with you individually.
Anthem Blue Cross and Blue Shield partners with a network of doctors and hospitals to meet your needs, your representative will review your provider options which are available in our provider directory with all HMO plans.
You must get authorization to get medical service outside the network, except for out of area dialysis urgent care and emergency room visits with PPO plans, authorization is not needed for medical services in the network or out of network. Most Anthem Blue Cross and Blue Shield plans offer prescription drug coverage, and in some regions, we have a network of preferred pharmacies that offer discounted drug rates.
Your representative will review your medications with you while on Original Medicare, if you haven't had prescription drug coverage you will be assessed a Part D late enrollment penalty of 1% each month you have been without coverage, this is a lifetime penalty Medicare.
Part D currently has a coverage gap or doughnut hole, each January your coverage renews and you have an initial coverage limit, if you go over that coverage limit on Part D medications, you will fall in the coverage gap. Every year there is an out-of-pocket spending limit, once you've reached the annual limit you will move into the catastrophic stage, in which you will pay small co-payments for the remainder of the year, information on drug coverage can be found in our formulary book, online formulary 1-800 Medicare or Medicare, Plan Finder.
If your medication isn't on our formulary we offer a transitional 30-day fill, some medications are subject to Part D step therapy, where you try other medications first if that's not a good solution you can work with your doctor to ask for an exception. Original Medicare offers extra help with Part D coverage, and your representative can review the income limits with you later, qualifying for this program will eliminate the late enrollment penalty and allow you to get covered medications with lower co-payments.
Now your representative will talk about how an Anthem Blue Cross and Blue Shield plan can help you.