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What Medicare Covers

Original Medicare covers a range of medical services and supplies in hospitals, doctors’ offices, clinics and other health care settings. Services are either covered under Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). Here’s a quick look at what Medicare covers under each part:

What Medicare covers — Part A

  • Inpatient hospital care
  • Skilled nursing facility care for inpatient skilled nursing and rehabilitative services
  • Inpatient Hospice Care
  • Religious nonmedical health care institution (Inpatient)

What Medicare covers — Part B

  • Doctors’ services (including office visits)
  • Preventive care such as bone density test and mammogram
  • Durable medical equipment
  • X-rays, MRIs, EKGs
  • Physical Therapy
  • Ambulance and Emergency Room

Medicare Advantage (Part C)

Medicare Advantage plans are partially funded by the federal government to help keep your costs low. Instead of supplementing Medicare to pay what Medicare doesn’t, it is a substitute for Original Medicare, providing all of your benefits in one plan. These plans:

  • Provide more coverage than Original Medicare, to help lower out-of-pocket costs.
  • May include medical coverage and Medicare–approved prescription drug coverage.
  • Feature predictable copayments, so you’ll always know what you’ll pay for visits to the doctor.
  • Provide coverage with lower out-of-pocket costs when you use the plan’s specific network of doctors, hospitals and other health care providers.

Medicare Prescription Drug Plan (Part D)

A Medicare-approved Prescription Drug Plan (PDP) (also referred to as Part D) may be sold separately and is available from private insurance companies. These plans:

  • Provide benefits that help to reduce your prescription drug costs.
  • Typically cover both brand–name and generic drugs.
  • Provide prescription drug coverage if you have Original Medicare or Original Medicare and a Medicare Supplement plan. (For information about covered benefits, limitations and exclusions, please see your coverage documents, as well as www.medicare.gov) May be part of Medicare Advantage plans.

Optional plan to help offset out–of–pocket costs

Medicare Supplement

Medicare Supplement insurance is designed to work with Original Medicare, to help pay costs that Original Medicare doesn’t cover. This coverage:

  • Helps to pay Original Medicare’s deductibles and copayments.
  • Gives you the freedom to choose your own Medicare–participating doctor — with no referrals needed for specialist care.
  • Is “standardized“ by the federal government — which means the benefits for each plan do not vary from one company to another. Price and service, however, may vary greatly from company to company.
  • Does not cover prescription drugs.

Save Money on Your Prescription Medications

As a Medicare Advantage plan member with Horizon Blue Cross Blue Shield of New Jersey, you have the trust and confidence of knowing you’re covered by the largest and most experienced health insurer in New Jersey.

When you need to see a doctor or specialist – or have to get lab tests or go to a hospital – our network of health care professionals and facilities offer quality care across the state.

But did you know there are ways to get more from your benefits? Let’s take a look.

The first way is to build a relationship with your Primary Care Physician, who can help you get healthy and stay healthy. How? Your PCP provides preventive care to monitor your health and well-being – all at no cost to you.

Your doctor can identify risk factors and symptoms that lead to chronic conditions or disease, and can help coordinate your care with other doctors or specialists.

So watch for reminders when you’re due for preventive care. We’ll tell you when it’s time to get your flu shot, diabetes screening, or other certain cancer screenings.

And, when you get certain preventive screenings, you can earn rewards in gift cards.

Another valuable way to get the most from your plan is by saving money on your prescription medications.

When you fill your prescriptions at a preferred pharmacy – including many popular retail chains such as Walgreens or CVS – you’ll save on the cost of your medications.

You can save even more when your doctor prescribes generics over brand-name drugs. Our pharmacy website can help you figure out the best possible savings.

For added convenience, many medications are available through our pharmacy mail order service – and can be delivered right to your door.

What about when you have a chronic condition? Our dedicated Care Managers help coordinate all of your healthcare needs and can help you understand what’s covered under your plan.

Care Managers identify your specific needs and develop a custom plan to help you manage ailments such as diabetes or high blood pressure. They can also help arrange services for you and can help you access other valuable resources.

How about when you need answers to health questions or wellness advice? Our 24/7 Nurse Line is available around the clock for reliable information on getting and staying well.

You’ll get safe, expert advice, and you can either call or chat online about any symptom or illness, or ask about any health-related concerns.

You can also get convenient medical care by phone or online via chat or video. Members can talk with a U.S. board-certified licensed doctor, 24 hours a day, 7 days a week – no appointment needed.

What’s more, you can easily access all of your plan information by registering and signing in to our secure member website at HorizonBlue.com.

With 24/7 access to all the details of your plan, you’re connected to care and support when and where it’s convenient for you. You can find a doctor, check claims, view your ID card and more.

Understand and make the most of your Horizon Medicare Advantage plan today.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

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