LegacySM Medigap benefits

Legacy Medigap information

Medigap basics

Blue Cross Blue Shield of Michigan (BCBSM) offers Legacy Medigap insurance policies for Plans A and C only. Other Michigan insurance carriers may offer other or additional plans, but Medigap plans can be sold in only 10 standard plans plus one high-deductible plan. (Plans A-D, F, G, K, L, M and N. Plans E, H, I and J are no longer available for sale.) Every insurer must make Plan A available. Plan A covers basic benefits:

BASIC BENEFITS: For Plans A - D, F, G, K, L, M and N

Plan A B C D F/F* G
Basic Benefits x x x x x x
Skilled Nursing     x x x x
Part A Deductible   x x x x x
Part B Deductible     x   x  
Part B Excess         100% 100%
Foreign Travel Emergency     $250 deductible $250 deductible $250 deductible $250 deductible

*Plan F also has an option called a high deductible Plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year deductible ($2,110 in 2013). Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible.

Basic Benefits for Plans K, L, M and N include similar services as plans A-D, F and G, but cost-sharing for the basic benefits is at different levels.

Plan K L M N
Basic Benefits 100% of Part A hospitalization coinsurance and preventive care 100% of Part A hospitalization coinsurance and preventive care 100% of Part A hospitalization coinsurance, including hospice 100% of Part A hospitalization coinsurance, including hospice
50% Hospice cost-sharing 75% Hospice cost-sharing    
50% of Medicare-eligible expenses for the first three pints of blood 75% of Medicare-eligible expenses for the first three pints of blood 100% of Medicare-eligible expenses for the first three pints of blood 100% of Medicare-eligible expenses for the first three pints of blood
50% Part B coinsurance 75% Part B coinsurance   Part B copays up to $20 for office visits and up to $50 for emergency room visits
Skilled nursing coinsurance 50% skilled nursing facility coinsurance 75% skilled nursing facility coinsurance 100% skilled nursing facility coinsurance 100% skilled nursing facility coinsurance
Part A Deductible 50% Part A deductible 75% Part A deductible 50% Part A deductible 100% Part A deductible
Part B Deductible        
Part B Excess        
Foreign Travel Emergency     $250 deductible $250 deductible
  $4,800 out of pocket Annual Limit** $2,400 out of pocket Annual Limit**    

** Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called "Excess Charges." You will be responsible for paying excess charges. The out-of-pocket annual limit will increase each year for inflation. The value here is for plan year 2013.

Choose a Legacy Medigap plan option that meets your needs

Please download the Legacy Medigap plan brochure (PDF) for a detailed outline of coverage.

Download the Legacy Medigap plan brochure (PDF) to compare benefits and premiums among policies, certificates of coverage and contracts and premiums offered by Blue Cross Blue Shield of Michigan and other plans. Visit the Premiums page for more information about plan premiums.

The outline of coverage does not give all the details of Medicare coverage. This outline shows benefits and premiums of policies sold for effective dates on or after Jan. 1, 2013. Policies sold for effective dates prior to Jan. 1, 2013, have different benefits and premiums. Plans E, H, I, and J are no longer available for sale. For information about your Medicare Part A and Part B coverage, contact your local Social Security office or consult Medicare & You. Medicare benefits are subject to change. Please consult the latest Choosing a Medigap policy: Guide to Health Insurance for People with Medicare.

Note: The Legacy Medigap plan may not fully cover all of your medical costs. When you receive covered services from a provider that does not accept Medicare assignment, you are responsible for the difference between the provider's charge and the Medicare-approved amount, plus any deductible or coinsurance amounts required by the Legacy Medigap policy you select.

Once enrolled in Legacy Medigap, we'll send you a member ID card. The following is only an outline describing the most important features of Blue Cross Blue Shield of Michigan's Legacy Medigap certificate of coverage. The certificate of coverage is your contract with Blue Cross Blue Shield of Michigan. You must read the certificate to understand all of the rights and duties of both you and BCBSM. For more information about Legacy Medigap coverage, call 1-888-563-3307. TTY users should call 1-800-481-8704.

Like Medicare, Legacy Medigap coverage is accepted nationwide and the plan is easy to use. There are no provider networks or referrals: Just use any health care provider that accepts Medicare. Simply present your Legacy Medigap ID card along with your red, white and blue Medicare health insurance card whenever you receive health care services. We'll coordinate payment with Medicare and your health care providers. In most cases, you'll never have to bother with claim filing or paperwork.

Important information about these plans

Medicare Plus Blue and Prescription Blue are PPO and PDP plans with a Medicare contract. Enrollment in Medicare Plus Blue and Prescription Blue depends on contract renewal.

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/.

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.

Medicare Plus Blue PPO and Prescription Blue PDP

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.

Limitations, copayments and restrictions may apply.

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.

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.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and or copayments/coinsurance may change on Jan. 1 of each year.

Medicare beneficiaries may enroll in Medicare Plus Blue PPO or Prescription Blue PDP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. BCBSM does not control Medicare's website and is not responsible for its content. You may only enroll in Medicare Plus Blue PPO or Prescription Blue PDP during specific times of the year.

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.

LegacySM Medigap

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.