Medicare Plus Blue PPO Pre-Enrollment Brochure · 2020-06-09 · Your plan will have a yearly limit on your out‑of‑pocket costs for medical services. Once you reach the yearly

Confidence comes with every card.®

Make the Most of Medicare

2017

Medicare Plus Blue is a PPO plan with a Medicare contract. Enrollment in Medicare Plus Blue depends on contract renewal.

www.bcbsm.com/medicare

Medicare Plus BlueSM PPO

Medicare can be hard to understand. We’re here to break it down for you. This easy guide will:

• Help you better understand your Medicare options by learning how Medicare works

• Introduce you to Medicare Advantage and our 2016 4‑stars out of 5 stars Medicare Plus Blue PPO plans

• Suggest five steps to help you find a Medicare plan that fits your lifestyle and finances

• Help you make the most of your hard‑earned benefits

Follow the steps, enroll in a plan, and a right‑coverage‑for‑you smile is sure to follow.

1 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.2 BCBSM Provider Enrollment System July, 2016.

We want to help you smile like this in your retirement, too.

Welcome to your enrollment kit

Medicare Plus Blue PPO Benefits brochure has at‑a‑glance details.

Summary of Benefits itemizes each PPO plan’s benefits.

Star Rating sheet explains the star rating our plans have received from the Centers for Medicare & Medicaid Services.1

Seminar flier gives times, dates and locations of meetings you can attend.

Enrollment form and business reply envelope include instructions on how to complete and mail.

Our network of doctors and hospitals spans the country. Most providers accept Blue Cross Blue Shield of Michigan coverage, and 95 percent of all Michigan doctors participate with us. Here at home, nearly every hospital in Michigan is in our network.2

The provider network may change at any time. You will receive notice when necessary.

STEP 1 Take a few minutes to look through the materials in your enrollment kit. We’ve filled it with practical resources and tips so you can make the most of Medicare.

How do we know? Our Medicare Plus Blue PPO Essential, Vitality, Signature and Assure plans fall into three levels of coverage. One is sure to fit your needs. Consider the summaries below and decide which best describes you and your preferences.

Light — Essential PPO Lower monthly premiums and higher out‑of‑pocket costs for those who are healthy and don’t take medications

Balanced — Vitality PPO and Signature PPO Balance between cost and coverage for those who visit the doctor and take some medications

Extended — Assure PPO Higher monthly premiums and lower out‑of‑pocket costs for those who often need care and medications

See Medicare Plus Blue PPO Benefits brochure for a plan benefit overview and premium costs by county and the PPO Summary of Benefits for more detailed benefit information.

Our Medicare Plus Blue plans use a preferred provider organization. That means you can see any doctor and visit any health care facility you choose without a referral. Staying in the PPO network, though, means less money out of your pocket.

• Our benefits go beyond Original Medicare, and may include dental, vision and hearing.

• Unlike Original Medicare, your out‑of‑pocket spending has an annual limit.

• Part D prescription drug coverage is included.

• You'll pay in‑network costs with BlueCard® travel benefits when you get care from participating Blue Cross physicians and hospitals that accept Medicare outside the state of Michigan.

• BlueCard® urgent care and emergency care benefits apply worldwide.

• You’ll have one member ID card, one bill and one customer service contact.

youforright

A that's planIt’s all about the plan.

And we have one for you.

Our PPO plans are full of value and can help you stay within budget

Yes, prescription drug coverage is includedMost of our PPO plans include Part D prescription drug coverage. Our network includes 98 percent of Michigan pharmacies3, and when you use Express Scripts or Walgreens Mail Order there’s no extra cost for home delivery.4 Our extensive retail pharmacy network outside Michigan includes most retail chain pharmacies as well.

You can review our approved drug lists, known as formularies, at www.bcbsm.com/formularymedicare. As a PPO member, if you’re taking a drug that’s not on our approved drug list or a drug that is subject to additional requirements or limits, you may be able to get a temporary supply. Your doctor can help you request an exception or choose an alternative drug on our list. Use the contact information on the back cover to get more details about our drug transition policy.

Welvie® empowers youAn astounding one in five people will have surgery this year.5 If you’re one of them, you’ll learn firsthand what a great resource our Welvie program is. Designed by surgeons, it walks you through the entire decision‑making process, from diagnosis to recovery, in a unique internet based, step‑by‑step process.6

BlueCard® travels when you doWhen you travel, you’re always covered for medical emergencies and urgent care. You are covered anywhere in the U.S. at in‑network rates when you use a participating Blue Cross provider that accepts Medicare.

Care management and behavioral health services when you need themOur health care management services help you stay healthy, enhance your quality of life and support recovery. If you have a condition that qualifies you, your own care management nurse will build a personal care plan for you. For emotional or mental distress, including depression and drug or alcohol abuse, a specialized case manager will work with you to get the right care and services arranged.

We cover you

beyondOriginal Medicare

3 January 2015 NCPDP/BCBSM‑BCN Pharmacy Network database. The pharmacy network may change at any time. You will receive notice when necessary.4 Walgreens and Express Scripts® are independent companies contracted by Blue Cross Blue Shield of Michigan to provide pharmacy mail order services to our members.5 Welvie Claims Analysis, 2014.6 Welvie is an independent company contracted by Blue Cross Blue Shield of Michigan to provide services to our members. Welvie provides a surgery decision support program.

Stay informed with

MyBlueSM Medicare

Learn about health trends,

lifestyle news and more from

our award‑winning member

magazine MyBlueSM Medicare.

As you evaluate your Medicare options, consider these potential costs:

� Deductible — the amount you must pay before your plan begins to

pay its share

� Coinsurance — the percentage of the cost of the service you pay

� Copayment — a fixed dollar amount you pay for health care services,

such as an office visit, medical test or prescription drug

� Out‑of‑pocket maximum — the most you have to spend for copays,

coinsurance and deductibles in any given year

STEP 2 Choose the best plan for your health and your wallet.

STEP 3 Review the plan's Summary of Benefits, which describes what the plan covers, what it doesn't cover and what your share of the costs will be. Note: it is not a list of every service, limitation or exclusion.

STEP 4Answer the questions on the next page to be sure the plan you choose matches your needs and priorities.

What's the Best plan for you?

How do you decide which plan fits?As you consider your Medicare Plus Blue PPO plan options and estimate your costs, answering these questions can help you choose wisely:

Are the doctors and hospitals that I want in the network of the plan I’m considering?How often do I see my primary care doctor? How often do I see a specialist?How many times have I been in the hospital in recent years?What prescription drugs do I take? Are my prescription drugs costly?How much do I travel within Michigan, the U.S., the world?Would a fitness membership benefit me? Do I need preventive dental, vision or hearing benefits?

Buy or build You can get your Medicare coverage one of two ways:

You can buy a complete package — a Medicare Advantage plan. A Medicare Advantage plan can stretch your Medicare dollars, combining coverage into a single, convenient plan with extra benefits that often includes prescription drug coverage.

Or you can build your own package of Medicare coverage, starting with Original Medicare Part A (which you likely qualify for based on your work history) and Part B (covers medical services and is required by the government to have Medicare drug coverage). You can add Part D, which is stand‑alone drug coverage. Then you can add a Medicare Supplement plan.

Buying coverage packaged together in one plan is a popular option. That’s supported by a recent report by the Henry J. Kaiser Family Foundation.

“Medicare Advantage enrollment has increased in virtually all states over the past year. Almost one in three people on Medicare (31% or 17.6 million beneficiaries) is enrolled in a Medicare Advantage plan in 2016.”7

Part AOriginal

Medicare

Part BOriginal

Medicare

Part CMedicare

Advantage

Part DPrescription

drugs

Medicare Supplement

(Medigap)

CMedicare Supplement

»Hospital care » Skilled nursing facility care »Hospice »Home health care

»Doctor visits »Mental health care »Outpatient surgery » Lab tests »Durable medical equipment

» Everything in  Parts A and B »Many plans cover prescription drugs »Most plans include a fitness program membership, dental and vision »Other added benefits complete the triangle

» Prescription drugs

»Helps pay some of the out‑of‑pocket costs you have with Original Medicare

7 Source: May 11, 2016, The Henry J. Kaiser Family Foundation

Improve your overall well‑being with Healthways SilverSneakers® Fitness program, another benefit for our members. This energizing program offers options that allow you to work out when, where and how you want. SilverSneakers includes:

A fitness membership with access to all basic amenities at more than 13,000 locations nationwide, plus SilverSneakers group exercise classes at many locations

SilverSneakers FLEX™ classes, such as dance, tai chi, yoga and walking groups offered in neighborhood locations, such as parks, recreation centers and adult‑living communities

SilverSneakers Steps® to use at home for those who have a disability, are recovering from a medical procedure or illness, live in a rural area or experience traffic difficulties and can’t make it to a fitness center

Online resources include tools to assess your health and track your activity, fitness advice, meal plans and healthy recipes to download, and connection with the SilverSneakers community for added support

SilverSneakers® Fitness membership

You must use network facilities to obtain this benefit. Healthways is an independent company not associated with the Blue Cross Blue Shield Association. Blue Cross Blue Shield of Michigan and Medicare Plus Blue contract with Healthways to offer the SilverSneakers Fitness program benefit.

Healthways, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Healthways, Inc. and/or its subsidiaries. ©2016 Healthways, Inc. All rights reserved.

To find fitness locations or learn more about the program, visit silversneakers.com or call SilverSneakers at 1‑866‑584‑7352 8 a.m. to 8 p.m. Eastern time, Monday through Friday. TTY users call 711.

Things to know about Medicare Advantage plansYou’re still in Medicare.

In most cases, you enroll in a plan for a year.

You can only join a plan at certain times during the year.

You still get complete Part A and Part B coverage as long as you continue to pay your Part B premium.

Your plan will have a yearly limit on your out‑of‑pocket costs for medical services.

Once you reach the yearly out‑of‑pocket limit of a plan, you pay nothing for covered services.

You can call the plan before you get care to see if the service is covered and what your cost may be.

You can join a plan even with a pre‑existing condition, with the exception of end stage renal disease, or ESRD.

Call a Blue Cross Blue Shield of Michigan representative or meet with an independent Blue Cross agent at a place and time convenient for you. We believe it’s an important step to finding the right plan for your lifestyle, health and budget. As a company that's received a 4‑star rating out of 5 for three years in a row, we've proven our ability to deliver high quality products and services, and we can guide you to a plan that fits best.

STEP 5 Ask us questions. Medicare can be confusing and complex, whether you’re enrolled now or making a first‑time decision as you turn 65. We know you want to make the most of your hard‑earned benefits.

Annual Enrollment PeriodOnce you’ve joined Medicare, the Annual Enrollment Period is Oct. 15 through Dec. 7. During the enrollment period, you can:

• Join a Medicare Advantage medical plan or Part D prescription drug plan

• Switch to a different Medicare Advantage medical plan or Part D prescription drug plan

• Change from a plan with Medicare Part D prescription drug coverage to one without it (you cannot join a Medicare Advantage plan that includes Part D drug coverage and a stand‑alone Part D plan at the same time)

• Disenroll from a Medicare Advantage plan

With Medicare Advantage, special circumstances may mean you have a Special Election Period during which you can switch your plan, including if you:

• Are moving out of your current plan’s service area

• Move into or out of a facility, such as a nursing home

• Qualify for extra help (you get both Medicare and Medicaid, receive Supplemental Security Income or apply for and receive federal financial help, or you’re a beneficiary of the Part D low income subsidy)

Be sure you can join the plan You’re eligible to enroll in a PPO Medicare Advantage plan if:

• You’re entitled to Medicare Part A and are enrolled in Medicare Part B. You must continue to pay your Medicare Part B premium. It’s a separate premium you pay to Medicare.

• You’re a resident of Michigan, meaning you reside in the state at least six months each year.

• You don’t have ESRD, except under certain conditions, according to federal law.

We have a contract

with MedicareWhen you enroll in one of our PPO plans, Blue Cross Blue Shield of Michigan provides your benefits, not Original Medicare. You’ll only need to show your Blue Cross member ID card for care. You should put your red, white and blue Medicare card away for safekeeping.

We have a contract

If you’re turning 65, you can enroll in a Medicare Advantage PPO plan during your Initial Enrollment Period, which is shown below. This seven‑month window starts three months before your birthday month and runs until three months after your birthday month.

If you miss signing up for Medicare during that time, you can enroll between Jan. 1 and March 31 of each year. Your start date will then be in July of the year you enroll.

When to enroll

Medicare Advantage disenrollment is easy, too

You can disenroll from your Medicare Advantage plan and switch to Original Medicare anytime between Jan. 1 and Feb. 14 each year. If you make the switch during that time, you’ll have until Feb. 14 to add a Medicare Part D prescription drug plan.

Your Medicare coverage will begin the first day of the month after the plan gets your enrollment request.

Beware of the late enrollment penalty

If you don’t enroll in a Part D prescription drug plan when you first become eligible, or if you have a break in coverage of at least 63 consecutive days, Medicare may add a late enrollment penalty to your Part D plan premium. If you sign up for a Medicare Advantage plan during your initial enrollment period when you’re turning 65, you’ll avoid that penalty.

3»months before

2»months before

1»month before

Yourbirthday month

«1month after

«2months

after

«3months

after

Seven‑month window

Enroll in a Medicare Advantage PPO plan online,

by phone or by filling out and mailing in the

enclosed application form.

You’ll need your red, white and blue Medicare card.

Anyone eligible for Medicare in your household must

enroll separately.

No payment is needed when you enroll.

We'll send a letter to confirm your intent to join

the plan. This usually happens within 30 days.

Once enrolled, you’ll get a Blue Cross member

ID card and packet about how to use and make the

most of your benefits.

Many things about Medicare can be complex, but enrolling is pretty simple

Learn more, compare plans or enroll in a Medicare Plus Blue PPO planCall a sales representative at 1‑888‑563‑3307 from 8 a.m. to 9 p.m. Eastern time, Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users call 711.

Attend a free Blue Cross learning event about Medicare. See the schedule of seminars included in your kit.

Visit a Blue Cross walk‑in center.

Contact an independent agent licensed to sell Medicare Plus Blue PPO plans.

Complete the enclosed application and mail it to us.

Enroll on our website at www.bcbsm.com/medicare.

Go to the CMS Medicare Online Enrollment Center at www.medicare.gov.

Blue Cross walk‑in centers Visit one of our walk‑in centers to meet with a certified health plan advisor or independent Blue Cross agent who’s able to sell Medicare Advantage plans. Blue Cross walk‑in centers are open from 9 a.m. to 4:30 p.m. Monday through Friday. Visit www.bcbsm.com/index/health‑insurance‑help/locations.html to see maps, get directions and find out when agents are available.

Other important information This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

Ann Arbor • Detroit • Flint • Grand Rapids • Holland • Lansing Marquette • Portage • Southfield • Traverse City • Utica

H9572_S_17MPBPPOPrenrllBK CMS Accepted 09032016

DB 15800 SEP 16 R055408