Important Information About Medicare Plans
Medicare Plus BlueSM, Blue Cross® Medicare Private Fee for Service, BCN AdvantageSM and Prescription BlueSM are PPO, PFFS, HMO-POS, HMO and PDP plans with Medicare contracts. Enrollment in Medicare Plus Blue, Blue Cross Medicare Private Fee for Service, BCN Advantage and Prescription Blue depends on contract renewal.
Premiums vary by county. You must continue to pay your Medicare Part B premium. You may enroll in only one Part D plan at a time.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums, and or copayments/coinsurance may change on Jan. 1 of each year.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
If you decide to have your plan premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.
Medicare beneficiaries may enroll in BCN Advantage HMO-POS and HMO, Medicare Plus Blue PPO, Blue Cross® Medicare Private Fee for Service or Prescription Blue PDP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. BCN and BCBSM do not control Medicare's website and is not responsible for its content. You may only enroll in BCN Advantage HMO-POS and HMO, Medicare Plus Blue PPO or Prescription Blue PDP during specific times of the year.
In the event the Governor of your state, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic area, be assured that Blue Cross Blue Shield of Michigan and Blue Care Network will continue to provide benefits based on the plan you are enrolled in. You will still be able to visit your doctor, urgent care facility or hospital if needed. Generally, during a disaster, your plan will allow you to obtain care from out-of-network providers at in-network cost-sharing. Our website will be updated if a disaster or public health emergency has occurred.
BCN Advantage℠ HMO-POS Elements, Basic, Classic and Prestige plans
BCN Advantage℠ HMO-POS Elements, Basic, Classic and Prestige are available in these counties: Alcona, Alpena, Allegan, Antrim, Arenac, Barry, Bay, Benzie, Branch, Calhoun, Charlevoix, Cheboygan, Clare, Clinton, Crawford, Eaton, Emmet, Genesee, Gladwin, Grand Traverse, Gratiot, Hillsdale, Huron, Ingham, Ionia, Iosco, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Lapeer, Leelanau, Lenawee, Livingston, Luce, Mackinac, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawassee, St. Clair, portions of St. Joseph*, Tuscola, Van Buren, Washtenaw, Wayne and Wexford. Premiums vary by county.
Our point of service benefit allows you to get care from providers out of our network under certain conditions. If you're traveling outside of Michigan, you're covered under our BlueCard benefit and can access doctors, specialists or hospitals that participate with Blues plans. You may receive most plan covered services at in-network, out-of-pocket cost sharing. You may need to pay higher cost sharing for routine care from non-network providers.
* St. Joseph county includes only these zip codes: 49011, 49030, 49052, 49072, 49093 and 49097.
BCN AdvantageSM HMO ConnectedCare, MyChoice Wellness, HealthySaver plans
BCN Advantage℠ HMO ConnectedCare is available only to residents of Arenac, Genesee, Iosco, Kalamazoo, Livingston, Macomb, Oakland, Saginaw, St. Clair, Washtenaw and Wayne Counties. BCN Advantage HMO MyChoice Wellness is available only to residents of Kent, Oceana, Ottawa, and Muskegon counties. BCN Advantage℠ HMO HealthySaver is available only to residents of Arenac, Genesee, Iosco, Kalamazoo, Kent, Livingston, Macomb, Muskegon, Oakland, Oceana, Ottawa, Saginaw, St. Clair, Washtenaw and Wayne Counties. You must use BCN Advantage ConnectedCare, MyChoice Wellness, and HealthySaver plan providers except in emergency medical or urgent care situations or for out of area renal dialysis. If you obtain routine care from out of network providers without prior authorization from the plan, neither Medicare nor BCN Advantage will be responsible for the costs.
Medicare Plus Blue PPO
Medicare Plus Blue PPO is available to all Medicare beneficiaries who are Michigan residents and are entitled to receive services under Medicare Part A and enrolled in Part B.
With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers. Your responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare-allowed amount and the contracted amount is lower. You may receive services from any provider who accepts Original Medicare. Your out-of-pocket costs will be lower if you choose a network provider. To find a network provider, visit http://www.bcbsm.com/medicare/find-a-doctor/.
Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. For a decision about whether we will cover an out-of network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Prescription Blue PDP
Prescription Blue PDP is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and/or enrolled in Part B.
Blue Cross Medicare Private Fee for Service
A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.
BCN Advantage HMO-POS and HMO plans
For more information, call the Customer Service number on the back of your ID card from 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Certain services are available 24/7 through our automated telephone response system. You may also write to: BCN Advantage, MC A103, 2311 Green Road, Ann Arbor, MI 48105.
Medicare Plus Blue PPO or Prescription Blue PDP
For more information, please contact Blue Cross Blue Shield of Michigan at 1-888-563-3307. TTY users call 711. Hours are: 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14.
BCN AdvantageSM HMO-POS Basic, Classic and Prestige plans and BCN AdvantageSM HMO ConnectedCare, MyChoice Wellness, and HealthySaver plans
You must use a network pharmacy to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Our pharmacy network includes the majority of chain pharmacies, mail order through Express Scripts Pharmacy® (mail order) or Walgreens, as well as long-term care and home infusion pharmacies. For more information, call the Customer Service number on the back of your ID card from 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Certain services are available 24/7 through our automated telephone response system. You may also write to: BCN Advantage, MC A103, 2311 Green Road, Ann Arbor, MI 48105.
Medicare Plus Blue PPO and Prescription Blue PDP
Our network includes approximately 2,400 Michigan retail pharmacies, representing approximately 98 percent of all Michigan pharmacies. Nationwide, most chain pharmacies are in our network, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies.
In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances; for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. Quantity limitation and restrictions may apply. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Member Services at 1-877-241-2583, 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14. TTY users call 711. Certain services available 24/7 through our automated telephone response system. You may also write to: Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd., Mail Code X521, Detroit, MI 48226.
Legacy Medigap offers access to any hospital, doctor or other health care provider in the U.S. or its territories that accepts Medicare assignment. The plan does not require members to use a specified provider network. Legacy Medigap is a Medigap health insurance policy administered by Blue Cross Blue Shield of Michigan. Neither Blue Cross Blue Shield of Michigan nor agents authorized to sell Blue Cross Blue Shield of Michigan policies are connected with Medicare.
Basic Blue Rx PDP
MII Life, Inc., a Medicare contractor, is an independent licensee of the Blue Cross® and Blue Shield® Association and the underwriter for Basic Blue® Rx, a prescription drug plan. Enrollment in Basic Blue Rx depends on contract renewal. Blue Cross and Blue Shield of Michigan is an independent licensee of the Blue Cross and Blue Shield Association.