What do you get when you enroll in Medicare Plus Blue PPO? The confidence that comes with affordable, all-in-one coverage that is simple to understand. You also get value for your health care dollar with coverage that may include vision, dental, hearing and fitness benefits — more than Original Medicare!
You can choose from four plan options that feature no referrals, Part D prescription drug coverage, and the freedom to choose any doctor or hospital that accepts Original Medicare.
With Medicare Plus Blue PPO, you get the coverage you want from the company you trust.
You'll like our plan:
- Lower out-of-pocket costs when you receive services from a doctor or hospital in our network
- Out-of-pocket maximums help limit your annual expense
- One ID card for health, drug, and preventive dental coverage (vision and dental as applicable)
- Available statewide
- No referrals needed to see specialists
- Worldwide emergency care coverage
- Virtually no paperwork
You'll like our benefits*:
- Over-the-counter bathroom safety bars
- Vision benefits
- Hearing benefits
- Fitness benefits
- Medicare Part D prescription drug coverage
- Preventive dental services
- Preventive tests and physicals
- Office visits
- Outpatient surgery and services
- Lab and radiology services
- Home health care
- Chiropractic services
- Prostate cancer screening exams
- Ambulance services
View a chart with premiums by county for more information.
In addition to our medical and prescription drug plans, Medicare Plus Blue PPO offers members a variety of programs designed to promote good health, safety and savings.
Choose from four Medicare Plus Blue PPO plans
- Medicare Plus BlueSM PPO Essential — Our most cost-effective PPO plan.
- Medicare Plus BlueSM PPO Vitality — Our most fundamental PPO plan.
- Medicare Plus BlueSM PPO Signature — Our most popular PPO plan.
- Medicare Plus BlueSM PPO Assure — Our most comprehensive PPO plan.
Click here to learn more.
Contact your Blues contracted agent
Contact your Blues contracted agent or an independent agent licensed to sell Blues Medicare Advantage plans, or call us for more information:
Representatives are available 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30; 8 a.m. to 9 p.m. Eastern time, with weekend hours Oct. 1 through Feb. 14.
If you're turning 65 or qualify for Medicare under special circumstances, you don't have to wait for Medicare's annual enrollment period, from Oct. 15 through Dec. 7. Call the Member Services number above for more information.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048, 24 hours a day, seven days a week;
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m. Monday through Friday. TTY users call 1-800-325-0778; or
- Your state Medicaid Office.
Your plan provider is required to notify the plan or arrange for prior authorization or certification in all applicable instances including: Inpatient Admission notification, High-Tech Radiology prior authorization, and Skilled Nursing, Long Term Acute Care, and Inpatient Rehabilitation prior certification. If a claim is denied, you will not be held responsible for the charge if the denial is due to a lack of prior notification, authorization, or certification.
About your Part D coverage
The formulary, or list of covered drugs, for Medicare Plus BlueSM PPO and Prescription BlueSM PDP includes medications selected to meet members' needs. However, if you and your physician feel you need a drug that is not included on the Medicare Plus Blue PPO and Prescription Blue PDP formulary, but it is a covered Medicare Part D drug, you may ask us for a coverage determination or an exception.
Coverage Determination, Grievance or Appeal form
H9572 S5584_W_Jan14BCBSMAdvWeb CMS Approved 01292014
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.
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.