Information for current individual plan members

Use these links to access information about your plan

Evidence of Coverage
How to get your Evidence of Coverage forms or print them yourself.
Commonly used forms
Commonly used Medicare Advantage and prescription drug plan forms.
Claim forms
Forms for Medicare Part D prescription drugs claims, vaccine and administration claims, and reimbursement.
Formulary
A formulary is a preferred list of drugs selected to meet member needs. It covers both generic and brand-name drugs.
PPO Provider/Pharmacy Directory
As a Medicare Plus BlueSM PPO member, you can see any doctor or hospital that will accept your Medicare Plus Blue PPO ID card. Your out-of-pocket costs will be lower if you see doctors and hospitals in our network.
Summary of Benefits
A summary of your plan's benefits, including monthly premiums and any deductibles and copayments.

Use these links to access additional resources

Contact information
How to get in touch with a sales representative or Member Services center.
Extra Help: Low-Income Subsidy
People with limited incomes may qualify for extra help to pay for their prescription drug costs.
Grievances, coverage determinations and appeals
For specific guidelines set by the Medicare program about how you can make a complaint, how the complaint must be classified, and the timelines in which we must address and respond to your complaint.
Member discounts and wellness programs
In addition to our medical and prescription drug plans, we offer members a variety of programs designed to promote good health, safety and savings.
Medication Therapy Management Program
If you're in a Medicare drug plan and have complex health needs, we can help you get the best results from the drugs you use.
Prescription drug determination
You have the right to ask us for an exception if you believe you need a drug that is not on our formulary, believe you should get a drug at a lower copayment, or are requesting an exception to the step therapy or prior authorization requirement for a drug.
Mail order pharmacy services
Using the Mail Order Pharmacy Service for your ongoing prescription drugs is easy, convenient and can be cost-saving.
Part D prescription drug transition policy
Review our policy about formulary transitions under certain conditions.
Free seminars
Attend a free seminar to learn about Medicare and the Blues plan options or how to transition into Medicare.
Member publications
This page provides links to member publications.
Privacy practices
Where to go to find answers to your questions or if you would like additional information regarding our privacy practices.

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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.