Why You Should Consider a Medicare Advantage Plan

People think when they turn 65, they are automatically enrolled in Medicare or the coverage is complete. That is not the case. 

Original Medicare is the government health insurance program for people ages 65 and older. There are some gaps in coverage for original Medicare. 

For example, original Medicare does not cover the cost of medication. Members also pay 20 percent of the costs for the care they receive. 

That’s where BlueCross BlueShield of South Carolina’s Medicare plans come in. 

“What I tell people is to do something. Either get on a Medicare Advantage plan or a Medicare Supplement plan, but don’t leave yourself exposed,” says Don Edwards, vice president of Medicare at BlueCross. “If you’ve worked all of your life to save for retirement, one high-dollar medical experience could wipe it out.” 

What is Medicare Advantage?

Medicare Advantage is also known as Part C. These plans offer the same benefits of original Medicare with greater coverage. The coverage includes prescription drug coverage and other supplemental benefits that original Medicare doesn’t cover — dental, vision, gym membership or over-the-counter drug store benefits. 

BlueCross offers two Medicare Advantage plans that have annual limits on out-of-pocket costs. Members pay small copays for services — such as $10 to see a primary care provider. If or when a member reaches the annual limit, the plan pays 100 percent for covered services for the rest of the year. 

One of the misunderstanding about original Medicare is that it is free and covers all of an individual’s medical expenses. This is not true. 

Anyone on original Medicare should know they have zero financial protection. Medicare pays 80 percent for Part A (hospital insurance) and Part B (medical insurance). Members pay the remaining 20 percent. 

There is no limit to the amount a member may have to pay out of pocket and the member would still be required to purchase a Part D (prescription drug plan) to have drug coverage and avoid a penalty. 

Medicare enrollees may owe a late enrollment penalty if they do not have a Medicare Prescription Drug Plan [Part D], a Medicare Advantage plan or credible prescription drug coverage.

With Medicare Advantage, members pay a low monthly premium or no premium — depending on the plan — for more complete coverage and other benefits. 

BlueCross Medicare Advantage plans have network providers that offer members annual physicals, preventive care and diagnostic procedures at no additional cost so they can stay healthy. 

An often overlooked benefit of a Medicare Advantage plan with BlueCross is the financial protection of the $6,700 out-of-pocket limit per year. Instead of paying a percentage of every bill, members pay low copays and never more than the annual limit. 

Only about 1 percent of members ever reach the out-of-pocket limit because so much of the health care is covered at no cost for preventive coverage. 

Who should consider a Medicare Advantage plan? 

Everyone should consider some type of Medicare plan other than or in addition to the original coverage, Edwards says. 

When picking a plan, enrollees should not just look at the monthly premium, according to Edwards. 

“A $0 premium doesn’t tell the whole story,” he says. “Find out how much it costs to use the plan.” 

Medicare Advantage plans are best for anyone who cannot afford Medicare Supplement coverage but wants to be covered and take advantage of all the BlueCross benefits. Or for people that want to take advantage of the all-inclusive benefits.

What are the benefits of a BlueCross Medicare Advantage plan?

A full list of the benefits with a BlueCross Medicare Advantage plan can be found here.

The more popular benefits include: 

  • Prescription drug coverage, plus dental, hearing and vision coverage included at no extra cost.
  • A large network of doctors and hospitals, plus no referrals.
  • Gym memberships or at-home fitness kits from Silver&Fit®*.

Edwards says the real benefit of BlueCross’ Medicare Advantage plans, though, is the range of preventive care or diagnostic care for no cost. For example, members can get a colonoscopy, mammogram, ultrasound or electrocardiogram for free rather than paying a percentage of the cost. 

“We keep the costs down as much as we can so the members can actually afford to use our plans,” he says. “We feel like if they use our plan then they will stay healthy. We have a healthy member, and they have a better quality of life. You get more care and more service for less out-of-pocket costs.” 

Why choose BlueCross?

By choosing BlueCross, members know they are supporting the only health insurance company located in the state. When a member calls BlueCross, he or she is speaking with another South Carolinian. 

“You are not a number with us. You are our neighbors,” Edwards says. “We are in Columbia, South Carolina, and we take care of our own people.”  

BlueCross customer service is also top-notch, with more than 90 percent of calls answered within 30 seconds. Customer service reps strive for one-call resolution with members. That keeps members off the phone to do what makes them happy.

BlueCross also has one of the largest networks in the state. Every hospital in the state accepts BlueCross Medicare Advantage plans.  

When to enroll

Now is the time to consider options for Medicare. The enrollment period for Medicare runs until Dec. 7. Changes made this enrollment period will take effect Jan. 1, 2020. 

While there is another enrollment period January through March, individuals cannot add a Medicare Advantage plan at that time. This enrollment period is for switching Medicare Advantage plans. 

Individuals won’t be able to pick up a Medicare Advantage plan until next enrollment period in fall 2020. You can only make changes if you are eligible for certain special enrollment periods (SEPs). Information about what qualifies you for an SEP can be found on the Medicare website

How to find more information 

Those who want to learn more about Medicare and picking the right plan can attend a Medicare 101 course at a BlueCross retail location in Columbia, Greenville or Mount Pleasant. Agents in their communities can also offer help picking the right plan. 


*Silver&Fit is an exercise and healthy aging program administered by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated, an independent company that offers these services on behalf of BlueCross BlueShield of South Carolina.

Nov. 7, 2019

Active senior living Hover image

“What I tell people is to do something. Don’t leave yourself exposed.”
— Don Edwards, vice president of Medicare at BlueCross

90 percent of BlueCross customer service calls are answered within 30 seconds

The enrollment period for Medicare ends Dec. 7. 

“You are not a number with us. You are our neighbors.” — Don Edwards  

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