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Plan 65 — Medicare Supplemental Health Coverage

As you approach age 65, do you know how Medicare works?

It can be overwhelming, but it doesn't have to be. Blue Cross and Blue Shield of Kansas (BCBSKS) is here to help make the transition to Medicare as smooth as possible for you.

Medicare is the federal health insurance program for people age 65 and older and others with disabilities. Medicare coverage is divided into several parts that provide coverage for different health care services. To learn more about Medicare and its parts, visit medicare.gov today.

Medicare does not cover all health care expenses. That's why BCBSKS created Plan 65 — a supplemental plan to help bridge the gaps in Medicare coverage. If you have Medicare and you purchase an additional Plan 65 Supplement Plan, Medicare will pay its share of the Medicare-approved amount for covered health care costs, and then your Plan 65 policy pays its share. Our plans are designed specifically to supplement the expenses Medicare does not pay, so you have less out-of-pocket expenses to worry about.

See how Plan 65 works with Medicare

Harry broke his leg and was admitted to his local hospital for treatment.

The amounts below are for the services Harry received during treatment.

Medicare

Hospital charge = $4,000

What Medicare pays = $2,684

What Harry will have to pay (Medicare deductible and coinsurance) = $1,316

Doctor charge = $2,000

What Medicare pays = $1,453.60

What Harry will have to pay (includes $183 deductible and 20% of all other charges) = $546.40

Total Harry pays = $1,862.40

Medicare + Plan 65 Plan F

Hospital charge = $4,000

What Medicare pays = $2,684

What Plan 65 Plan F pays = $1,316

What Harry pays = $0

Doctor charge = $2,000

What Medicare pays = $1,453.60

What Plan 65 Plan F pays = $546.40

What Harry pays = $0

Total Harry pays = $0

* These amounts paid by BCBSKS are based on the Plan F supplemental plan. The amounts paid may vary based on the supplemental plan you choose.


Here are some essentials you need to know before getting started with a Plan 65 Medicare supplemental plan:

1

To apply for one of our Plan 65 plans, you must already be enrolled in Medicare Parts A and B. If you are not yet enrolled in Medicare, contact your local Social Security Office.

A

Medicare Part A

This covers you when you're a patient in a hospital or skilled nursing facility. You're eligible for Part A if you or your spouse paid into Social Security for at least 10 years through your employment, and you are a citizen or permanent resident of the United States. Part A is free for most people, but it does have a substantial deductible and copayments.

2

There are multiple ways that you can be guaranteed coverage for a Plan 65 plan. For example, if you apply within six months of your Part B effective date or if you are coming off a group policy, you have 63 days from coming off your group policy to apply.

B

Medicare Part B

This covers your physician services, outpatient treatment, lab services and more. This coverage requires a monthly premium, which most people have deducted from their Social Security check, plus an annual deductible and coinsurance to pay.

3

In order to get coverage for your prescription drugs, you may consider a Medicare Prescription Drug Plan (Part D). This is a separate plan that only covers prescription drugs.

D

Medicare Part D

This covers your prescription drug needs. Short-term or long-term, brand name or generic, your prescriptions are covered.

Currently a BCBSKS member enrolled in Blue MedicareRx? Here are some things for you:

If you are newly eligible for Medicare and are seeking coverage for Medicare Part D, learn more here.

See what plans we offer

Outline of coverage chart

Medicare's Standard Plans A Through N

Compare and select from Plans A, C, F, G, K or N offered here by Blue Cross and Blue Shield of Kansas

  • Plan 65
    Plan A

    • Basic Benefits
  • Plan B

    • Basic Benefits
    • Part A Deductible
  • Plan 65
    Plan C / Select

    • Basic Benefits
    • Skilled Nursing Facility Coinsurance
    • Part A Deductible
    • Part B Deductible
    • Foreign Travel Emergency
  • Plan D

    • Basic Benefits
    • Skilled Nursing Facility Coinsurance
    • Part A Deductible
    • Foreign Travel Emergency
  • Plan 65
    Plan F / Select F*†

    • Basic Benefits
    • Skilled Nursing Facility Coinsurance
    • Part A Deductible
    • Part B Deductible
    • Part B Excess (100%)
    • Foreign Travel Emergency
  • Plan 65
    Plan G / Select

    • Basic Benefits
    • Skilled Nursing Facility Coinsurance
    • Part A Deductible
    • Part B Excess (100%)
    • Foreign Travel Emergency
  • Plan 65
    Plan K** / Select

    • Hospitalization and Preventive Care paid at 100%; other Basic Benefits paid at 50%
    • 50% Skilled Nursing Facility Coinsurance
    • 50% Part A Deductible
    • $5,120 Out-of-Pocket Annual Limit***
  • Plan L**

    • Hospitalization and Preventive Care paid at 100%; other Basic Benefits paid at 75%
    • 75% Skilled Nursing Facility Coinsurance
    • 75% Part A Deductible
    • $2,560 Out-of-Pocket Annual Limit***
  • Plan M

    • Basic Benefits
    • Skilled Nursing Facility Coinsurance
    • 50% Part A Deductible
    • Foreign Travel Emergency
  • Plan 65
    Plan N

    • Basic Benefits, except up to $20 copayment for office visit, and up to $50 copayment for ER
    • Skilled Nursing Facility Coinsurance
    • Part A Deductible
    • Foreign Travel Emergency
    Plan-65 Select is available with Plans C, F, G & K.

* Plan F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as plan F after one has paid a calendar year deductible of $2,200. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed $2,200. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductible for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible.

† High Deductible Plan F is not available.

** Plans K and L provide for different cost-sharing for items and services than Plans A-G and M-N. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called “Excess Charges.” You will be responsible for paying excess charges.

*** The out-of-pocket annual limit will increase each year for inflation.

See Premiums for a 65-year-old in 2017

Dollar amounts shown are for 2017 premiums and may change on January 1, 2018.

Plan A
$117.56
Plan C
$156.92
Plan F
$163.17
Plan G
$144.49
Plan K
$78.80
Plan N
$114.50
*Plan C Select
$111.64
*Plan F Select
$118.66
*Plan G Select
$105.07
*Plan K Select
$62.29
Premiums for a 65-year-old

Dollar amounts shown are for 2017 premiums and may change on January 1, 2018.

Plan A
$117.56
Plan C
$156.92
Plan F
$163.17
Plan G
$144.49
Plan K
$78.80
Plan N
$114.50
*Plan C Select
$111.64
*Plan F Select
$118.66
*Plan G Select
$105.07
*Plan K Select
$62.29

You may be able to save because of where you live!

Our Plan 65-Select plans are available in “select” counties throughout Kansas. To see if the county you live in is eligible for our Select plans, review our hospital list here.

hospital

Hospital Limitations

Plan 65-Select plans offer a lower monthly premium* and hospital network limitations. In other words, you can reduce your premium if you agree to use a "select" network hospital in the service area where you enroll for all hospital care that is not an emergency. If you receive non-emergency hospital services at a non-network hospital, you will be responsible for payment of the Part A deductible and applicable coinsurance charges.

If your doctor does not have admitting privileges to a network hospital, you must have your doctor refer you to another doctor who has admitting privileges to a network hospital. Or you may choose another doctor who can admit you to a network hospital.

If you move outside of the hospital network service area, you may continue to use a network hospital. If your move is permanent and it's no longer convenient for you to use a network hospital, you have the opportunity to convert to a Plan 65 non-restricted policy.

* Lower monthly premium compared to traditional Plan 65.


What you need to do to prepare for Medicare

Having Medicare Part A and Part B is a good start to the coverage you need, but did you know the out-of-pocket expenses can sky rocket without a Medicare supplemental plan to help cover other costs? This chart will help you see where Medicare benefits stop and your responsibility begins.

Service
Medicare Pays
You Have to Pay

Medicare Part A

Hospital

First 60 days of an admission

All but $1,316* deductible / benefit period

$1,316*

61st to 90th day

All but $329* a day

$329* a day

91st to 150th day

All but $658* a day

$658* a day

Beyond 150 days

Nothing

100% of expenses

Skilled Nursing Facility

First 20 days per Medicare benefit period

100% of approved costs

Nothing

21st to 100th day

All but $164.50* a day

$164.50* a day

Beyond 100 days

Nothing

100% of expenses

Blood

 

All blood except the Medicare calendar year blood deductible (first 3 pints) if the deductible is not met by the blood replacement

Medicare's calendar year blood deductible (first 3 pints) if the deductible is not met by the blood replacement

Medicare Part B (Physician and Medical)

Medical Expenses

In or out of the hospital and outpatient treatment

Medicare requires you to pay a $183** calendar year deductible, then pays 80% of Medicare-approved charges after you satisfy this deductible

$183** annual deductible, then pay the 20% of Medicare-approved charges NOT paid by Medicare

Clinical Laboratory Service

Blood tests for diagnostic services

100% after $183** Part B deductible

$183** Part B deductible

Other Benefits Under Medicare

Medically Necessary Emergency

Care Received in a Foreign Country (except in some parts of Canada & Mexico)

Nothing

100% of expenses

Preventive Services

 

A one-time routine physical within six months of joining Medicare at age 65; coverage of screening blood tests for the early detection of cardiovascular disease; coverage of diabetes screening tests for persons at risk

100% of expenses

Outpatient Prescription Drugs

 

Medicare has established a standard basic benefit under Part D to help beneficiaries pay for prescription drugs. If you want the benefit, you need to join a private plan

Costs will vary based on the plan and benefit level you select

*This is the 2017 deductible and copayment for Medicare Part A (Hospital and Skilled Nursing Facility Care) and may change on January 1, 2018.

**This is the 2017 deductible for Medicare Part B and may change on January 1, 2018.

†After 90 days of hospitalization, Medicare benefits are paid from a one-time lifetime reserve of 60 additional days, which are not renewable each benefit period. Here is a list of key services not covered by Plan 65 Benefit Plans: custodial and intermediate nursing home care costs; most dental care and hospital admissions for such care; routine physical examinations and tests, routine foot care and immunizations except injection of pneumococcal vaccine, mammograms and prostate exams; hearing aids, eyeglasses or contact lenses and examinations about them; and benefits considered medically unnecessary.


Turning 65 soon? Follow these steps to prepare for Medicare:

There are things you can be doing now to prepare for Medicare when you turn 65. Let's look at what you can be doing throughout the year before turning 65.

9-12 months prior to your 65th birthday

  • Step 1

    Step 1 iconMeet with the employee benefits manager if you are still working (or at a former job) to discuss retiree health benefits.

  • Step 2

    Step 2 iconStart reading up on Medicare: eligibility, Medicare's Parts, what it does and doesn't cover and when to enroll. Visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for complete enrollment details.

  • Step 3

    Step 3 iconAsk your doctors if they participate in Medicare and if they accept Medicare assignment.

6 months prior

6 months prior

3 months prior

  • Step 4

    Step 4 iconGet health insurance quotes for Medicare supplemental plans. You are guaranteed acceptance with BCBSKS when enrolling within six months of your Part B effective date or 65th birthday.

  • 3 months prior

  • Step 5

    Step 5 iconApply for Medicare benefits (Part A and B) if retiring at age 65 (and not already receiving Social Security benefits) three months before your 65th birth month.

  • Step 6

    Step 6 iconEnroll in a Medicare supplemental plan. Remember – Medicare supplemental plans do not cover prescription drugs. This would need to be purchased separately. Learn more here.


Benefits of BCBSKS Plan 65 plans

Being the insurer Kansans trust with their health, more than 104,000 Kansans over age 65 enjoy our Plan 65 coverage. Here are some of the many advantages you can expect as a member of Plan 65:

  • Affordable premiums.
  • Optional dental coverage.
  • 24/7 access to BlueAccess®, our secure, online portal for members where they can view their recent Explanation of Benefits, prescription drug coverage, details about their deductible and coinsurance limits and much more.
  • No claim forms – claims are automatically filed when using a contracting provider and processed quickly.
  • Accepted worldwide – the BCBSKS ID card is recognized wherever you go.

Exclusions

Here is a list of key services not covered by Plan 65 benefit plans:

  • Custodial nursing home care.
  • Intermediate nursing home care costs.
  • Most dental care and hospital admissions for such care. Examples are treatment, filling, removal or replacement of teeth, root canal therapy, surgery for impacted teeth, and other surgical procedures involving the teeth or structures directly supporting the teeth.
  • Routine physical examinations and tests, routine foot care, and immunizations except injection of pneumococcal vaccine, mammograms and prostate exams.
  • Hearing aids and examinations for them, or consultations about them.
  • Eyeglasses or contact lenses and examinations for them, or consultations about them, unless for replacement of the lens following cataract surgery.
  • Benefits considered medically unnecessary by a committee of doctors representing Medicare and Blue Cross and Blue Shield of Kansas will not be paid.

Additional links to helpful websites


Questions? We're Here for You.

  • By phone
    • In Topeka, call us at 785-291-4301
    • Outside Topeka, call us toll-free at 1-800-752-6650
  • By email - Please provide a daytime phone number in your email and a time when you can be reached. A licensed representative will call you within two business days.

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Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.
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