2011 Platinum Blue (Cost) – flexible, lower-cost plan options
Original Medicare covers some of your health care expenses, but there are still deductibles, copayments and coinsurance that you must pay. Platinum Blue, a Medicare-approved Cost plan from Blue Cross and Blue Shield of Minnesota, can help. Platinum Blue offers you a choice of three plan options to help reduce your out-of-pocket costs for Medicare-eligible services and supplies.
|Monthly plan premium||$35||$79||$109|
|Office visits (primary care and specialists)||20% coinsurance||$10 copay||$0|
|Inpatient hospital||$400 copay per stay; plan covers 90 days each benefit period plus 60 lifetime reserve days||$100 copay per stay; no limit to the number of days covered each benefit period||$0; no limit to the number of days covered each benefit period|
|Emergency room visits in the United States and worldwide||$50 copay||$50 copay||$0|
(outside the service area within the U.S.)
|In-network benefits for up to 9 months||In-network benefits for up to 9 months||In-network benefits for up to 9 months|
|Annual out-of-pocket maximum||$3,000||$3,000||$3,000|
What else do I need to know before choosing this plan?
- Is your doctor in the network?
In Minnesota, you can see any provider in the Platinum Blue network. You can also go to providers outside the network, although you may only have Original Medicare benefits available and may pay more for those services. Providers may change during the year.
- Prescription drug coverage
Visit MedicareBlue(SM) Rx (PDP) to learn about prescription drug coverage options.
- Does this plan offer additional benefits, discounts or services?
Yes, learn about other features of this plan.
You must be a resident of Minnesota to enroll in Platinum Blue. You must also be entitled to Medicare Part A and enrolled in Medicare Part B, or enrolled in Part B only. You may not be eligible to enroll if you have permanent end-stage renal disease (kidney disease requiring dialysis or a kidney transplant), unless you are currently enrolled in a Blue Cross and Blue Shield of Minnesota plan.
Generally, you may enroll in a Cost plan at any time during the year. However, if you are a member of a Medicare Advantage plan, you may not be able to enroll if you are locked in to your current plan. Read important Platinum Blue disclaimers for additional details.
Download detailed information
- Benefits overview – 2011 plan (PDF)
- Summary of Benefits – 2011 plan (PDF)
- SilverSneakers Fitness Program (PDF)
- Grievances, initial determinations and appeals (PDF)
- Appoint a representative
- Evidence of Coverage for Core Option – 2011 plan (PDF) (see Chapter 7 for grievance, coverage determination and appeals information)
- Evidence of Coverage for Choice Option – 2011 plan (PDF) (see Chapter 7 for grievance, coverage determination and appeals information)
- Evidence of Coverage for Complete Option – 2011 plan (PDF) (see Chapter 7 for grievance, coverage determination and appeals information)
- Plan ratings (PDF)
- Blue Cross Privacy Notice (PDF)
- Get Acrobat Reader
How can I learn more?
Plans are available to residents of the service area. You must continue to pay your Medicare Part B premium. The benefits listed are for Medicare-eligible services and supplies received from in-network providers. Benefits, premiums and/or cost-sharing amounts may change on January 1, 2012. The benefit information provided herein is a brief summary not a comprehensive description of benefits. For more information contact the plan.
Blue Cross, Blue Shield, and the cross and shield symbols are registered marks of the Blue Cross and Blue Shield Association. Platinum Blue and MedicareBlue are service marks of the Blue Cross and Blue Shield Association. SilverSneakers® is a registered mark of Healthways, Inc., an independent company that provides fitness benefits.
Last updated May 2011
H2461_051011_J02 CMS Approval 05/16/2011