Frequently Asked Questions

You can start planning ahead. You can enroll starting 3 months before the month you turn 65 through to 3 months after your birthday month. This 7-month window is called your Initial Enrollment Period.

We strongly encourage you to enroll as soon as your enrollment period starts, so there will be less change of any gap in coverage with your new plan.

Medicare Part A and Part B coverage is effective on the first day of the month after CMS processes your application, or the Medicare Parts A & B effective date, whichever is later. The earliest someone who is turning age 65 can sign up for Parts A & B is three months before the month they will turn age 65.

Enrollment in Medicare Part A and B is done through the Social Security Administration (SSA). If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Part A at the start of your Initial Enrollment Period. However, you will need to contact SSA to sign up for Part B. Contact the Social Security Administration:

• Visit SSA online at www.ssa.gov, or
• Visit in person at your local SSA office, or
• Call SSA at 1-800-772-1213 (TTY 1-800-325-0778)

Most people should enroll during the Initial Enrollment Period (IEP), and SSA will send you enrollment instructions at the beginning of your IEP. This is the period during which you can enroll in Medicare for the first time. It is a seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and runs for three months after the month you turned 65. For example, if you were born in June, your window to enroll is March 1 through September 30.

If you do not receive instructions from the SSA, call them or visit their website to enroll in Medicare. Because enrollment takes time to process, if you plan to retire at 65, we recommend enrolling three months prior to your 65th birthday. 

Medicare is individual insurance, so you wouldn't be on the same plan. If you and your spouse or partner are both turning 65, you would each get your own Medicare plan. 

If your spouse is younger, they may be able to stay on your group plan if you aren't retiring. Your company may also offer COBRA if you do retire. Or you can look at an individual plan for them as a bridge until they can get their own Medicare plan.

Part A will not cost you anything if you or your spouse paid into Social Security for a minimum of 10 years. You pay a premium each month for Part B. Your Part B premium will be automatically deducted from your benefit payment if you get benefits from one of these:

• Social Security
• Railroad Retirement Board
• Office of Personnel Management 

If you don’t get these benefit payments, you will receive a Part B premium bill.

The Part B and Part D monthly premiums may change from year to year, depending on your income reported on your tax return. 

It’s important to stay on top of payments. Non-payment of Part B premiums and/or the IRMAA surcharge will result in your coverage being canceled.

Your employer may help cover the cost of your premiums when you sign up for Medicare. Each employer can set the amount they cover. This is called a defined contribution.

Check with your employer to see if their plans include a defined contribution. 

If your company or union offers a group Medicare plan, your Human Resources department or benefits administrator can give you all the details you need.

If they don’t offer a group Medicare plan and you’re looking for an individual Medicare plan, visit our shopping site.

Group Medicare plans often have richer benefits than individual plans. Many employers or unions offer a subsidy (defined contribution plan), which can lower your costs.

You can only be enrolled in one Medicare plan at a time. We can help as you move to your new plan.

Medicare Advantage plans, also called Medicare Part C, are plans offered by private health insurance companies like Blue Cross and Blue Shield of New Mexico and regulated by the government. These plans expand on the benefits of Medicare Parts A and B. For example, Blue Cross Group Medicare Advantage Open Access (PPO)℠ includes extra benefits like the SilverSneakers^® Fitness Program, a 24-hour nurse advice line, and discount programs.

With a Blue Cross Group Medicare Advantage Open Access (PPO) plan, you can go to any providers who:

1. Accept Medicare
2. Agree to see you as a patient
3. Agree to bill the plan.

They do not need to be part of any Blue Cross and Blue Shield network.

Members’ coverage levels are the same inside and outside their plan service area nationwide for covered benefits. Referrals aren’t required for office visits. Prior authorization may be required for certain services from Medicare Advantage-contracted providers with BCBSNM.

Note: Even Medicare-assigned providers can decide which patients they want to see, except in an emergency. We recommend that you confirm with providers that they will accept your Open Access PPO plan and file claims with the plan. Share the Your Providers, Your Personal Network flier with your providers. It explains your Open Access plan and how to submit claims.

Many companies offer these benefits to eligible retirees. Check with your benefit administrator for details about what is available to you.

If you enroll in a group retiree Medicare plan, your coverage cannot be canceled, your claims cannot be denied, nor can your premium be increased because of a pre-existing condition.

Yes. To participate in a retiree group Medicare plan you will continue to pay Part B premiums.

Your benefit administrator will provide directions. They may provide an enrollment kit or website for you to visit for more information about your options and instructions for enrolling.

No. However, enrollment in one of the group Medicare plans offered by your employer or union is required to qualify for a defined contribution (subsidy). If you decline retiree medical coverage, you might not be able to re-enroll yourself or your dependents later. 

Check with your benefit administrator to make sure you understand the consequences of declining coverage.

Under the Blue Cross group Medicare Advantage (PPO)℠ plan you can visit any provider that accepts Medicare. If you choose to see an out-of-network doctor, your costs may higher than if you’d chosen an in-network provider.

With the Blue Cross Group Medicare Advantage Open Access (PPO)℠ plan, you can visit providers that:

• Accept Medicare
• Agree to see you as a patient
• Agree to bill the plan

They don't need to be part of any Blue Cross and Blue Shield network.

All major national retail and grocery pharmacy chains participate in the BCBSNM pharmacy network. Search for pharmacies by ZIP code using the Pharmacy Finder  or call customer service for help.

All network pharmacies offer members BCBSNM's contracted rates. You can spend less on your drug costs by shopping for the best price at any participating pharmacies or by using mail-order pharmacies. See the Helpful Tools page for details.