Medicare Plus Blue PPOSM and BCN Advantage HMO-POSSM are health plans with Medicare contracts. Prescription Blue PDPSM is a stand-alone prescription drug plan with a Medicare contract.
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 www.bcbsm.com/medicare/provdirectory.shtml.
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.
Limitations, copayments and restrictions may apply.
Our network includes approximately 2,300 Michigan retail pharmacies, of which an estimated 86 percent are network 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 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. You may also write to: Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd., Mail Code X435, 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 herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on Jan. 1, 2013.
Medicare beneficiaries may enroll in Medicare Plus Blue PPO, BCN Advantage HMO-POS or Prescription Blue PDP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For more information, please contact Blue Cross Blue Shield of Michigan at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704.
You may only enroll in Medicare Plus Blue PPO or Prescription Blue PDP during specific times of the year. To learn more about enrollment periods, please contact Member Services.
BCN Advantage HMO-POS
BCN Advantage HMO-POS is available in these counties: Allegan, Barry, Bay, Calhoun, Clinton, Eaton, Genesee, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Kent, Lapeer, Livingston, Macomb, Midland, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Saginaw, Shiawassee, St. Clair, Tuscola, Van Buren, Washtenaw and Wayne. Premiums vary by county. You must continue to pay your Medicare Part B premium.
You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor BCN Advantage will be responsible for the costs. Out-of-network services authorized by BCN Advantage will be covered. Our point-of-service benefit allows you to get care from providers not in our network under certain conditions. If you are traveling outside of Michigan, you are covered under our point-of-service BlueCard benefit and can access out-of-network 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.
If you are enrolled in BCN Advantage ClassicSM or PrestigeSM 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 Medco or Walgreens, as well as long-term care and home infusion pharmacies. For additional information on network pharmacies, call Customer Service at 1-800-450-3680, 8 a.m. to 8 p.m., seven days a week. TTY users should call 711. You may also write to: BCN Advantage, 2311 Green Road, Ann Arbor, MI 48105. The BCN Advantage benefit information provided on this website is not comprehensive. Additional information should be requested before making a decision about your coverage. For full information on BCN Advantage benefits, current members should call our Customer Service department at 1-800-450-3680, from 8 a.m. to 8 p.m., seven days a week. TTY users should call 711. Prospective members should call 1-877-469-2583, from 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-481-8704.
Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1, 2013. Contact BCN Advantage for details.
If you decide to have your BCN Advantage 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 through the Centers for Medicare & Medicaid Services (CMS) Online Enrollment Center, located at medicare.gov. For more information, contact the BCN Advantage at 1-877-469-2583.
BCN Advantage is issued by Blue Care Network, which contracts with the federal government. BCN Advantage's contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.
