Alyssa Lane
Blue Cross Blue Shield (BCBS) is a nationwide health insurance program that offers a range of health insurance options to its members. BCBS has been providing Medicare coverage for over 90 years and is trusted by most doctors for this purpose. The program is committed to making healthcare insurance affordable and attainable for all, with a range of small business plans and flexible group insurance plans for businesses of any size. BCBS members can access their online accounts to manage their health insurance plans, checking on claims, paying bills, and contacting a representative.
| Characteristics | Values |
|---|---|
| Medicare eligibility | Initial Enrollment Period: when you first become eligible for Medicare. This is a seven-month window. |
| You qualify for Medicare due to End-Stage Renal Disease (ESRD). | |
| You don't qualify for premium-free Part A coverage. | |
| You are eligible for Social Security or Railroad Retirement Board (RRB) benefits but don't receive them. | |
| You can choose a Medicare Advantage plan through a private insurer like Blue Cross and Blue Shield (BCBS) that covers all Parts A and B services and typically includes Medicare Prescription Drug (Part D) coverage. | |
| You can enroll in a BCBS Medigap (Medicare Supplement) plan if you are already enrolled in Original Medicare. | |
| You must first enroll in Medicare Part A and Part B before joining a Medicare Advantage plan. | |
| You live in Puerto Rico and receive Social Security benefits (you will be automatically enrolled in Part A). | |
| You are eligible for health coverage through your employer that is terminated (you may be eligible for a Special Enrollment Period when you can enroll in Part B). | |
| Small business plans | Offer a full range of health insurance options for groups with 2 to 50 or 100 employees, depending on your state. |
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What You'll Learn
Medicare eligibility
During this Initial Enrollment Period, you can choose to enrol in Original Medicare (Parts A and/or B) or opt for a Medicare Advantage plan through a private insurer like Blue Cross and Blue Shield (BCBS). BCBS offers comprehensive coverage, typically including Medicare Prescription Drug (Part D) plans. Additionally, if you are already enrolled in Original Medicare, you can enrol in a BCBS Medigap (Medicare Supplement) plan to enhance your coverage.
Special circumstances may also allow you to enrol outside of the Initial or annual Open Enrollment Periods. For instance, if you lose your employer-provided health coverage, you may be eligible for a Special Enrollment Period, enabling you to enrol in Part B and explore other Medicare options, such as Medicare Advantage.
Blue Cross Blue Shield offers a range of health insurance options, including Medicare plans, to meet the diverse needs of individuals and groups. They are committed to making healthcare insurance accessible, affordable, and attainable for all, with a focus on providing valuable coverage and peace of mind to their members.
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Small business plans
Blue Cross Blue Shield offers health insurance plans for small businesses. These plans aim to provide cost-effective, high-quality coverage tailored to the business and its employees. Blue Cross Blue Shield serves one in three Americans and has a comprehensive network of doctors and hospitals.
Small businesses can explore various options to meet their unique needs. For instance, the BlueCard® PPO plan is the nation's leading PPO network, providing affordable options with more than 2.2 million unique, in-network providers. The BlueSelect Network offers additional savings by guiding employees to select in-network providers delivering higher-quality care at a lower cost.
Blue Cross Blue Shield also offers Total Care, which incorporates patient-centred and data-driven practices to improve quality and outcomes. For businesses seeking to address the high costs of specialty care, Blue Distinction® Specialty Care targets 11 high-cost specialty care areas.
For small businesses in specific regions, there are additional plans available. In Louisiana, Blue Cross and Blue Shield offer the Blue Connect plan, which provides lower-priced, high-quality coordinated care. Members have access to the Ochsner Health Network and other participating providers, with options including POS, HSA-eligible qualified high-deductible plans, and an All Copay plan.
In the Greater Baton Rouge and Greater Monroe/West Monroe areas, the Precision Blue plan offers similar benefits to Blue Connect, while the Community Blue plan is tailored for businesses in the Greater Baton Rouge area.
In Maryland, Washington D.C., and Northern Virginia, CareFirst is the preferred choice for small business health insurance, with 78% of small businesses in these regions offering CareFirst plans.
Small businesses can thus benefit from the range of options provided by Blue Cross Blue Shield, ensuring their employees have access to affordable, quality healthcare.
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Initial Enrollment Period
The Initial Enrollment Period is a seven-month window for enrolling in Original Medicare (Part A and/or Part B) when you first become eligible. This period is based on the month in which you turn 65 and includes the three months before your birth month, your birth month, and the three months after your birth month. During this time, you can also choose a Medicare Advantage plan through a private insurer like Blue Cross and Blue Shield (BCBS) that covers all Parts A and B services and typically includes Medicare Prescription Drug (Part D) coverage.
If you live in Puerto Rico and receive Social Security benefits, you will be automatically enrolled in Part A but will need to apply for enrollment in Part B. Similarly, if you are eligible for Social Security or Railroad Retirement Board (RRB) benefits but do not receive them and qualify for Medicare due to End-Stage Renal Disease (ESRD), you can enroll during the Initial Enrollment Period.
The Open Enrollment Period, which happens annually from November 1 to January 15, allows anyone to enroll in an individual and family health insurance plan without requiring a life change. If you enroll by December 15, your coverage will begin on January 1 of the upcoming year; otherwise, your coverage will start on February 1.
Outside of the Initial and annual Open Enrollment Periods, certain situations may qualify you for a Special Enrollment Period. For example, if you have health coverage through your employer that is terminated, you may be eligible for a Special Enrollment Period to enroll in Part B or other Medicare options, such as Medicare Advantage.
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Special Enrollment Period
To qualify for a Special Enrollment Period outside of Open Enrollment, you typically need to experience a qualifying life event. Some of the most common qualifying life events include:
- Losing health coverage
- Getting married or divorced
- Having a baby, adopting a child, or placing a child for foster care
- Moving to a different permanent residence
Since a qualifying life event can happen at any time, you typically have 60 days before or 60 days following the qualifying event to enrol in or change your plan during an SEP. An SEP lets you enrol in health coverage or switch plans outside of an open enrolment period. SEPs can help you avoid gaps in your coverage and stay on top of your healthcare needs.
For example, if you have health coverage through your employer that is terminated, you may be eligible for a Special Enrollment Period when you can enrol in Part B, as well as other Medicare options, such as Medicare Advantage.
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BlueCard Program
The BlueCard® Program is an initiative by Blue Shield of California that links Blue plans across the United States and abroad through a single electronic network for claims processing and reimbursement. It allows for seamless processing of claims when a Blue plan member from one state seeks medical care in another state or abroad.
The BlueCard Program simplifies the process of submitting claims for out-of-state Blue plan members. California providers can use the tools and information provided by the BlueCard Program to submit claims to Blue Shield of California when a member of another state's Blue plan seeks medical care in California. This ensures that the claim is processed according to the member's benefits contract with their local Blue plan.
To verify eligibility for benefits through the BlueCard Program, providers can check the member's ID card for a three-character prefix. This prefix is used to identify the member's Blue plan and correctly route claims. If there is no prefix on the ID card, the member is not eligible for benefits through the BlueCard Program. Additionally, members with ID cards displaying the PPO suitcase logo are enrolled in Preferred Provider Organization (PPO) products and receive benefits through the BlueCard Program. Those without the suitcase logo are excluded from receiving benefits through the program.
Providers who participate in the Blue Shield of California network are encouraged to submit BlueCard claims electronically using the Claims Routing Tool. California providers who do not participate in the Blue Shield of California network may still send their claims to Blue Shield of California but may not receive in-network reimbursement from their local Blue plan. The BlueCard Program offers a variety of training options, including free webinars, to assist providers with understanding the program and managing out-of-state Blue plan patients.
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Frequently asked questions
Eligibility depends on the type of insurance plan you are interested in. Blue Cross Blue Shield offers a range of health insurance options, including Medicare, Medigap, and private insurance plans. To confirm your eligibility, you must verify your specific plan requirements.
Your Initial Enrollment Period for Medicare is a seven-month window that begins three months before your 65th birthday and ends three months after.
A Special Enrollment Period allows you to enroll in Medicare Part B and other Medicare options outside of the standard Initial or annual Open Enrollment Periods. This may apply if you lose your previous health coverage through an employer, for example.
Yes, Blue Cross Blue Shield offers flexible group insurance plans for small businesses with 2 to 50 or 100 employees, depending on your state.
You can verify your eligibility by contacting your local Blue Cross Blue Shield company or by logging in to your online account if you are already a member.
