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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

View Transcript

Prescription medications can cost a lot, especially if you take them on a regular basis.

If you qualify for Medicare, then you also qualify for prescription drug coverage, commonly known as Medicare Part D. Part D helps cover some of the cost of your prescription medications.

Even if you’re not taking prescription medications now, it’s a good idea to have coverage in place, in case your needs change in the future.

You can add a Medicare Prescription Drug Plan - Part D - to your Original Medicare coverage or you can enroll in a Medicare Advantage plan - Part C - that includes prescription drug coverage.

These plans are offered by private insurance companies like Horizon Blue Cross Blue Shield of New Jersey.

Horizon’s prescription drug coverage helps you pay less for your prescription medications.

Our prescription drug coverage includes zero dollar deductibles with certain Medicare Advantage plans and PDP enhanced plans; copays as little as one dollar for preferred generic prescription drugs when you use one of our preferred pharmacies; the convenience of 90-day, mail-order prescriptions delivered right to your home; an extensive list of covered prescription medications, both generic and brand-name; and a network of more than 1,500 pharmacies, including many popular retail pharmacies like CVS and Walmart.

Remember, you can save money by having your doctor prescribe generic drugs. The Federal Drug Administration ensures that generic medications are as safe and effective as their brand-name counterparts. That means you can significantly save on your prescription medications, without sacrificing quality or safety.

With Horizon’s Medicare prescription drug coverage, we make it more affordable for you to get the prescription medications you need.

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

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

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