Whether it's enrollment timing, accessing medical care when traveling, how coverage affects dependents, or avoiding fraud; Medicare can feel complicated. But you're not alone in having questions.
Use these links to jump to the answer you're looking for. Or simply scroll to browse the FAQ content. And if you have additional questions, please contact one of our Licensed Medicare Advisors.
The Highmark Medicare Reservations scheduler is your way to connect with a Licensed Medicare Advisor to ask questions and learn more about choosing a plan that's right for you. Meet with an advisor at your convenience:
Connect with a Licensed Medicare Advisor now.
Medicare Part A covers overnight hospital stays and home care. It also covers follow-up nursing care and some in-home health care costs. If you're eligible for Medicare Part A, then you're also eligible for Part B. Medicare Part B covers the following types of services:
Medicare Part D is coverage that is added to a Medicare Advantage plan used for prescription drugs. Not all Medicare Advantage plans cover prescriptions, so it's important to consider Part D.
Medicare Advantage — also referred to as Medicare Part C — includes the benefits of Original Medicare (parts A and B). It offers additional coverage for:
Medigap helps reduce your out-of-pocket costs. While there are no additional benefits that come with Medigap, you can see any provider that accepts Original Medicare (Parts A and B). You need to have Medicare Parts A and B before you can purchase a Medigap plan. You’ll also be responsible for a monthly premium in addition to any premiums you may have from your Medicare Part B coverage.
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Original Medicare includes Part A and Part B and is provided by the federal government. Medicare Advantage is an all-in-one alternative offered by private insurers and may include extra benefits like dental, vision, hearing and prescription drug coverage. Medigap works with Original Medicare to help pay some out-of-pocket costs.
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Yes, you can be enrolled in VA benefits and Medicare at the same time. Using both gives you more options, flexibility, and freedom to choose between VA and non-VA providers in your Medicare network.
Plus, Medicare Advantage plans can come with extra benefits that most veterans don't get through the VA — such as over-the-counter allowances and transportation benefits.
Highmark offers $0 Medicare Advantage plans for veterans— Freedom Blue PPO Valor plan (Pennsylvania, West Virginia, and Delaware) and Freedom Valor PPO plan (Western New York) — specifically developed to work with VA benefits. It's a great choice for veterans who want to add coverage to the care they already receive through the VA.
A Licensed Medicare Advisor can help you review your options.
Your Medicare costs depend on the coverage you choose. You may pay monthly premiums, deductibles, copays or coinsurance. Some plans may also include prescription drug costs or extra benefits. Review your plan details before enrolling so you know what's covered and what you may pay.
Most people enroll for Medicare Parts A and B during their Initial Enrollment Period (IEP):
Good to know: If you have employer coverage, you may be able to delay Medicare enrollment without a penalty.
The Medicare Advantage Open Enrollment Period (OEP) is when you should review your current plan and then make any changes. Details about OEP:
The Medigap Open Enrollment Period lasts six months beginning on the first day of the month in which you are both age 65 and enrolled in Medicare Part B. Review your current coverage early so you don't miss your enrollment window or face penalties. A Highmark Licensed Medicare Advisor can help you confirm your timing.
You may have to pay a late enrollment penalty if you miss your window. It's important to understand your timeline when retiring to avoid unnecessary costs. Many people have eight months to enroll after employer coverage ends; missing that window may result in ongoing penalties.
Yes, under certain circumstances, you may qualify for a later enrollment period to make changes to your coverage. A Medicare Special Enrollment Period (SEP) allows you to make coverage changes in certain situations. For example, if you or your spouse plan to continue working past age 65, and will have employer-sponsored health coverage, an SEP can help you avoid late enrollment penalties or a gap in coverage. Special conditions include:
Yes, you may be able to delay Medicare enrollment without a penalty if you're still working and have coverage through your employer's group health plan. Whether you can delay enrollment depends on your specific situation and employer coverage, so it's important to review your benefits before making a decision.
You may be able to delay Medicare enrollment if you're covered under your spouse's employer health plan and your spouse is actively working for a company with 20 or more employees. For additional information, visit the AARP website.
No, Medicare does not automatically cover spouses or dependents. When planning for family coverage:
Since Medicare coverage isn't available for dependents, you'll need to purchase a new health plan for your dependents once you enroll in Medicare.
If your dependent is under 19 years of age, consider a program such as Children's Health Insurance Program (CHIP) or the Affordable Care Act (ACA). They might qualify if your family's income is too high to qualify for Medicaid and too low to afford private insurance.
Your family may stay on your employer plan temporarily through COBRA when you enroll in Medicare. COBRA coverage is time-limited and is meant to bridge coverage while they explore longer-term options. Keep in mind that COBRA leaves your dependent responsible for the full cost of the coverage, which could be expensive.
Coverage while traveling depends on the type of Medicare coverage you have. Original Medicare generally covers you anywhere in the U.S. if the provider accepts Medicare.
Medicare Advantage plans may have network requirements that affect coverage for non-emergency care, while Medigap plans can help pay certain out-of-pocket costs for Medicare-covered services. A Licensed Medicare Advisor can answer your questions and help you understand your coverage before you travel.
Many Medicare Advantage and Medigap plans cover emergency care abroad. However, Original Medicare doesn't typically cover care outside the U.S. Review your benefits before traveling internationally to avoid unexpected costs.
Many Medicare Advantage PPOs provide coverage wherever you travel — domestically or internationally. Medigap allows you to access any provider who accepts Medicare, no matter where you are. And Original Medicare has no location restrictions within the U.S.
Preparing in advance ensures access to medications and care. To ensure you have access to your medication, use in-network pharmacies when possible. Bring your Medicare and prescription coverage information when traveling, including:
Medicare fraud usually involves providers illegally invoicing the government for services that were never provided or billing at an inflated cost. Medicare scams typically include unsolicited calls asking for your personal information or someone trying to sell you unnecessary medical equipment.
Protect your Medicare number like you would your Social Security or credit card numbers. Only share your number with trusted providers. And shred documents containing personal information.
If you suspect Medicare fraud, report it right away. For Original Medicare, call:
For fraud related to a Medicare Advantage or supplemental plan, call the Medicare Drug Integrity Contractor at 877-772-3379. Before making a call, be sure to have:
Highmark provides invaluable resources for its members on how to avoid Medicare fraud and scams. These articles offer prevention tips and what to do and who to contact if you believe you're a victim of fraud.
You can request a replacement ID card through your health plan:
Highmark has helpful resources dedicated to helping you make the most of your Medicare planning. You'll learn more about:
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