Medicare Benefits Summary

This is a summary of Medicare coverage to assist you in making decisions about your health coverage when you leave your employment at Boston University after the age of 65. You are encouraged to use the Medicare web site: www.medicare.gov. The site provides detailed information about plans available and prescription drug coverage. It allows you to search for and compare plans specific to where you live.

Traditional Medicare

  • Part A (Hospital Insurance) pays some of the costs of hospitalization, limited skilled nursing home care, home health services, and hospice care. You pay nothing for this coverage.
  • Part B (Medical Insurance) covers physicians’ services, most outpatient hospital services, and certain related services. There is a $183.00 deductible in 2018 and and the cost is $134.00 premium (in 2018) per month.

Part C (Medicare Advantage Plan) includes HMOs, PPOs, Private Fee-for-Service plans, Special Needs plans, and Medical Savings Accounts. These are voluntary programs offered by private companies available to those who are Medicare beneficiaries. It is offered by private insurance companies including Blue Cross Blue Shield, Harvard Pilgrim Health Care, Fallon Community Health Plan, Tufts Health Plan, and others. You receive all of your care from the Medicare Advantage Plan while continuing to pay the Part B premium to Medicare. Medicare pays the Medicare Advantage Plan a percentage of what the government calculates an average subscriber would cost Medicare. In most cases, Medicare Advantage Plans operate similar to a Health Maintenance Organization (HMO) and provide more generous benefits than traditional Medicare with no deductibles, nominal copayments and no claim forms. However, your choice of providers is limited. You should ensure that the providers you wish to use are in the network of  the Medicare Advantage plan.

Eligibility Requirements
1.  You must be enrolled in Medicare Part A and Part B.
2.  You must reside within the service area.
3.  You do not have End-Stage Renal Disease.
4.  You are not enrolled in a Medicare Hospice Program.

Medicare Supplements provide traditional Medigap coverage for those using Medicare as their primary insurance. They are offered by private insurance companies including Blue Cross Blue Shield, Harvard Pilgrim Health Care, Fallon Community Health Plan, Tufts Health Plan, AARP and others. Medicare Supplements may cover some or all of Medicare cost-sharing amounts or “gaps” as well as services not covered by Medicare. Advantages are that you can seek care from any physician or hospital throughout the U.S. who accepts payment from Medicare; you don’t need to choose a Primary Care Physician (PCP); you don’t need to get referrals for specialty care; and there are no copayments for physician services.

Part D (Outpatient Prescription Drug Plan) provides prescription drug coverage. Like other insurance, if you join, there is a monthly premium, which varies by plan, and a yearly deductible. You will also pay a part of the cost of your prescriptions, including a copayment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium.

Your decision about Medicare prescription drug coverage depends on your personal needs and the kind of health care coverage you have. There are two ways to get Medicare prescription drug coverage:

  1.   You can join a Medicare prescription drug plan, or
  2.   You can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage. Go to www.medicare.gov for a list of plans available in the area where you live as well as what they cover and the costs.

Important Note: The level of prescription benefit coverage and the monthly cost varies greatly from plan to plan. You will need to determine the benefit level that is right for your individual situation.

Useful phone numbers and web sites:

AARP Health Care Options 1-800-643-4815 www.aarpmedicareplans.com
Blue Cross Blue Shield of Mass. 1-800-200-4255 www.bluecrossma.com/medicare-options/2018/
Harvard Pilgrim Health Plan 1-888-609-0692 https://hpforlife.org/
Tufts Health Plan 1-800-701-9000 www.tuftsmedicarepreferred.org
Medicare 1-800-633-2273 www.medicare.gov