Plan65. Medicare Supplement. Plan Options. Great health plans
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1 Plan65 Medicare Supplement Plan Options Great health plans Effective July 2018 through December 2018
2 The Blue Difference: Local plans, local service It s time to choose a Medicare supplement plan! It s a big decision, one that you want to get right. You ve come to the right place Blue Cross & Blue Shield of Rhode Island (BCBSRI). Since 1939, we ve been the hometown plan helping Rhode Islanders like you get the healthcare coverage that fits their needs. And because we re Rhode Islanders too, we know where you re coming from and what you need from a Medicare supplement plan. With many Plan 65 options to choose from, and lots of valuable extras that come with them, we are different. Great health plans start here: Plans that give you peace of mind Access to nationwide coverage Many programs to get (and stay) healthy and save money This book gives you everything you need to make the best Plan 65 choice. When you re ready, just ask us for help. We live and work in RI, too. Come in to Your Blue Store SM or give us a call...we re ready to show you how local plans and local service can make a big difference. Or you can go to bcbsri.com/medicare anytime. 2
3 A helping hand for Rhode Island Since 1939 BCBSRI has been a part of the local community. We share that sense of pride and independent spirit that s unique to Rhode Island, because this is our hometown, too. That s why we ve demonstrated a commitment to helping Rhode Islanders and Rhode Island-based organizations for many years, through awareness programs, board service, financial contributions, and volunteer efforts. Through our employee volunteer program, we donated nearly 8,500 hours to help 174 local organizations in 2017 alone. I believe that Blue Cross & Blue Shield of Rhode Island really cares about their members. I m a breast cancer survivor, so I really need to have good coverage that I feel comfortable with. Jackie, Medicare member Helping our members find a Second Act Many of our Medicare members want to serve our community by volunteering. That s why we created our Second Act program. In partnership with state agencies, Second Act matches our Medicare members with volunteer opportunities that help them make a difference and share their skills and time with others. To learn more, visit serverhodeisland.org or call (401) The Second Act program really makes me feel like I m making a difference. Try it I think you ll find it really rewarding. Lou, Medicare member and Second Act participant 3
4 Enrollment Made Easy Follow these steps to make enrolling in Plan 65 simple: 1. Make sure you are enrolled in Medicare Part A and Medicare Part B. 2. Decide which Plan 65 option best fits your needs. See page 5 for details. 3. Determine whether you want to add a dental plan to your coverage. (See page 11 for information.) 4. Do you want prescription drug coverage? If so, consider Blue MedicareRx, our prescription drug plan. (See page 11 for information.) You can get more information about these plans online at bcbsri.com/medicare, call us at ; TTY: 711, or visit Your Blue Store SM. (See back page for locations.) 5. Apply to Plan 65 (and Blue Cross Dental if you choose) by filling out the Plan 65 application and mailing it to: Blue Cross & Blue Shield of Rhode Island Medicare Sales Department 500 Exchange Street Providence, Rhode Island When can you enroll? * You may already know that there is a 6 month eligibility period to enroll in Plan 65. But did you know that you can enroll after you have retired from an active commercial insurance plan or have moved to Rhode Island from another state with prior Medicare Supplement or Medicare Advantage coverage? There may be other situations in which your enrollment may be guaranteed as well. Certain changes in your circumstances can qualify you to enroll in Plan 65. Please call the Medicare Sales Team for more information at (401) or * We may require documentation as evidence of your eligibility. Some exclusions may apply.
5 Introducing Plan 65 Medicare Supplement Plans Original Medicare (Medicare Part A and Part B) alone comes with deductibles and cost-sharing that can really add up. Our Plan 65 Medicare Supplement plans give you added coverage for peace of mind. Whether you want just a little extra coverage or a more expansive plan, or whether you get most of your care in Rhode Island or out-of-state, you ll find a plan to meet your needs and budget. And as always, our local Medicare Concierge Team will help you get the most out of your coverage. Take a look at our Plan 65 options below, which all provide access to any provider or hospital that accepts Medicare: Plan Out-of-pocket expenses Premium cost When to choose it Plan F $ $$$$$ Plan Select F * $ $$ Higher premiums with little to no out-of-pocket expenses Lower premiums with little to no out-of-pocket expenses when you use the Plan 65 Select Hospital Network NEW Plan G $$$ $$$ Balance of premium and out-of-pocket expenses of the Part B deductible NEW Plan N $$$$ $ Lower premiums with higher out-of-pocket expenses including Part B deductible and copayments for some office visits and ER services Plan A $$$$$ $$$$ Higher premiums and out-of-pocket expenses including Part A and Part B deductibles and copayments The Value of Blue You have a one-time opportunity ** to: 1. Transfer to an open Plan 65 option of your choice if you are coming from a BlueCHiP for Medicare plan effective October 1, 2013 or later with no lapses in coverage. 2. Transfer from Plan Select F to Plan F or vice versa. * Plan 65 Select F is not subject to the Part A deductible or Part A copayment when you use a hospital within the Plan 65 Select Hospital Network. If you use a non-participating Plan 65 Select Hospital for Medicare Part A benefits, you will be responsible to pay the applicable Medicare eligible expenses, Part A deductible, and/or Part A copayment. The network is subject to change at any time. ** Some exclusions may apply. Please call the Medicare Sales Team for more information at (401) or
6 Get more from your membership! Improve your health Gym membership discounts As a Blue Cross member, you can get the lowest available rate at more than 9,500 fitness centers nationwide through the International Fitness Club Network. Learn more at bcbsri.com. Classes and screenings at our retail stores Visit any of our 3 Your Blue Stores sm for exercise classes, nutrition seminars, nurse consultations, and health screenings, all at no additional cost. Visit bcbsri.com/yourbluestore to enroll. Save money EFT discounts If you choose our electronic funds transfer (EFT) payment option for your monthly premium, you will save $2/month. Discounts for non-tobacco users * If you are not a tobacco user, you ll enjoy reduced monthly premium rates. * Reduced rates are available by confirming you don t use tobacco on your application or completing the Tobacco Use Attestation Form after becoming a Plan 65 member. You can do more online Once you ve enrolled in a plan, register online at bcbsri.com/medicare, where you can: Sign up for exclusive member events throughout the year See detailed plan benefits View claims history Choose a doctor Find information to help you stay healthy 6
7 For Medicare members Issue 5 Enjoy convenience and peace of mind Mobile app Access your plan information and benefits, all from the palm of your hand, with the Your Blue Touch RI mobile app. Just download the app from the Apple or Google app store. * Weekend customer service Questions can pop up anytime, even on weekends. Get answers 7 days a week from our dedicated Medicare Concierge Team. (See back page for contact information.) Discover more tips online rhodeahead.com/medicare 3 Make these your best years Take free BCBSRI workshops introduced by radio host Patricia Raskin ways to save on prescriptions Easy veggie meals $ 0 Get fit for less! Stay informed Secure messaging service Sign up for the Your Blue Wire RI messaging service and receive reminders about your health and your plan sent right to your phone or mobile device. Text BCBSRI to and get started, or call * Standard mobile phone carrier and data usage charges apply. The downloading and use of the Your Blue Touch RI mobile app is subject to the terms and conditions of the app and the online stores from which it is downloaded. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play is a trademark of Google Inc. 7
8 Plan 65 Plan Options At-a-Glance Medicare Plan 65 F/Select F *+ Plan 65 G Benefit Features Medicare Pays Plan Pays You Pay Plan Pays You Pay Part A Services Hospitalization First 60 days All but $1,340 per benefit period $1,340 per benefit period $1,340 per benefit period Days All but $335 per day $335 per day $335 per day Days 91 and after while using All but $670 per 60 lifetime reserve days day $670 per day $670 per day Once lifetime reserve days are used, an additional 365 days Skilled nursing facility care First 20 days All approved amounts All but $ per day All Medicare eligible expenses All Medicare eligible expenses Days Up to $ Up to $ per day per day Days 101 and after All costs All costs Part B Services Part B excess charges All costs All costs Immunizations & Screenings Colorectal exam and prostate specific antigen (PSA) test 1 Lab services (Medicare-covered) Home health care (Medicarecovered) Hospice care Doctors visits All costs All but very limited copayment/ coinsurance Medicare copayment/ coinsurance Medicare copayment/ coinsurance Emergency room Outpatient surgery Diagnostic tests and X-rays Durable medical equipment and prosthetic devices Urgently needed care Ambulance services 80% 20% and $183 annual deductible 20% after $183 annual deductible is met $183 annual deductible Foreign travel care 80% to a lifetime maximum benefit of $50,000 20% after $250 annual deductible. There is a $50,000 lifetime maximum. 80% to a lifetime maximum benefit of $50,000 20% after $250 annual deductible. There is a $50,000 lifetime maximum Part A Deductible = $1,340 per benefit period Part B Deductible = $183 per calendar year. Medicare amounts are current for 2018 and may change on an annual basis. 1 Part B deductible may apply to Medicare approved doctor s visits. This is a summary of benefits. It is not a contract. For details about coverage, including any limitations or exclusions not noted here, please refer to the subscriber agreement [forms: Plan 65 F (1-18), Plan 65 Select F (1-18), Plan 65 G (7-18), Plan 65 N (7-18), and Plan 65 A (1-18)] or contact the Medicare Sales team at (401) or
9 Plan 65 N Plan 65 A Plan Pays You Pay Plan Pays You Pay $1,340 per benefit period $1,340 per benefit period $335 per day $335 per day $670 per day $670 per day All Medicare eligible expenses All Medicare eligible expenses Up to $ per day Up to $ per day All costs All costs Medicare copayment/ coinsurance 20% after $183 annual deductible is met 80% to a lifetime maximum benefit of $50,000 All costs Up to $20 copay per visit after $183 annual deductible Up to $50 copay per visit after $183 annual deductible $183 annual deductible 20% after $250 annual deductible. There is a $50,000 lifetime maximum. Medicare copayment/ coinsurance 20% after $183 annual deductible is met All costs $183 annual deductible All costs Plan 65 Select Hospital Network Listing * Plan 65 Select F is not subject to the Part A deductible or Part A copayment when you use the following hospitals in Rhode Island: Butler Hospital Kent Hospital Landmark Medical Center The Miriam Hospital Newport Hospital Our Lady of Fatima Hospital Rehabilitation Hospital of Rhode Island Rhode Island Hospital Roger Williams Medical Center South County Hospital The Westerly Hospital Women & Infants Hospital This list is subject to change. For the most up-to-date information, please call the Medicare Sales Team at (401) or If you use a non-participating Plan 65 Select Hospital for Medicare Part A benefits, you will be responsible to pay the applicable Medicare eligible expenses, Part A deductible, and or Part A copayment. The network is subject to change at any time. 9
10 Plan Rates Plan 65 offers age-attained rates so you can get the most out of your retirement with lower monthly premiums! Non-Tobacco User Rates * Age Range Plan 65 F Plan 65 Select F Plan G Plan N Plan 65 A Base rate $ $ $ $ $ Under $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ * These rates are available by attesting to no tobacco use on your application or completing the Tobacco Use Attestation Form after becoming a Plan 65 member. Rates are effective through June 30, Tobacco User Rates Age Range Plan 65 F Plan 65 Select F Plan G Plan N Plan 65 A Base rate $ $ $ $ $ Under $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Rates shown apply to members enrolling in Plan 65 within six months of becoming eligible for Medicare Part B. Additional restrictions may apply. These rates apply to members enrolling for the first time. For members enrolling under other situations, or for more information, please call the Medicare Sales Team at (401) or
11 Additional Products to Improve Your Plan We also offer these products that you can select to improve your coverage. Blue Cross Dental Direct Add a Blue Cross Dental Direct plan for full-body coverage and peace of mind. You ll get the convenience of carrying just one membership card for your medical and dental coverage. All of our Blue Cross Dental Direct plans come with: Our extensive network, which includes 9 out of 10 dentists in Rhode Island, plus national coverage coast-to-coast (more than 100,000 dentists) Coverage for out-of-network care Prescription Drug Plans Our Blue MedicareRx sm prescription drug plans (PDPs) offer Medicare prescription drug coverage to Rhode Island residents who are: Entitled to Medicare Part A and/or enrolled in Part B and Are not enrolled, or do not plan to stay enrolled, in another Medicare prescription drug plan or Medicare Advantage plan with Part D prescription coverage To learn more about Blue MedicareRx PDPs, including additional eligibility requirements, just ask our Medicare Sales Team. Blue MedicareRx (PDP) is a Prescription Drug Plan with a Medicare Contract. Enrollment in Blue MedicareRx depends on contract renewal. 11
12 We re here to help! From choosing a plan, to enrolling, to answering your questions once you re a member... we re your hometown plan. And you can trust us to help you every step of the way. By phone Contact the Medicare Sales Team at BLUE (2583) (TTY: 711). Hours: Monday through Friday, 8:00 a.m. to 8:00 p.m. (Open seven days a week, 8:00 a.m. to 8:00 p.m., from October 1 February 14) You can use our automated answering system outside of these hours. Already a Plan 65 member? Call the Medicare Concierge Team at (401) or (TTY: 711). Hours: October 1 - February 14, seven days a week, 8:00 a.m. to 8:00 p.m. February 15 - September 30, Monday through Friday, 8:00 a.m. to 8:00 p.m.; Saturday & Sunday, 8:00 a.m. to noon You can use our automated answering system outside of these hours. Online Visit bcbsri.com/medicare to compare plans, get recommendations, and apply. In-person at Your Blue Store Warwick: Cowesett Corners, 300 Quaker Lane East Providence: Highland Commons, 71 Highland Avenue Lincoln: Lincoln Mall Shopping Center, 622 George Washington Highway Store hours: Monday and Thursday - 9:00 a.m. to 7:00 p.m., Tuesday, Wednesday, and Friday - 9:00 a.m. to 5:00 p.m. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Insured by Blue Cross & Blue Shield of Rhode Island. The purpose of this communication is the solicitation of insurance. You may be contacted by a licensed producer or insurance company. These policies have exclusions and limitations. Please call the Medicare Sales Team at (401) or , or your agent for complete details of coverage and costs. 500 Exchange Street Providence, RI bcbsri.com/medicare Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. 05/18 PL
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