2012 Platinum Blue (Cost) – great value in a comprehensive medical plan 

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 pay these costs and provide additional benefits and services.

Plan benefits chart ― Choose from three plan options:
Platinum Blue
Core Plan
member pays:		Platinum Blue
Choice Plan
member pays:		Platinum Blue
Complete Plan
member pays:
Monthly plan premium$35$79$119
Deductible$0$0$0
Doctor office visits (primary care, specialists, chiropractic and podiatry services)20% coinsurance$15 copay$0
Inpatient hospital care$500 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 care$50 copay$50 copay$0
Travel coverage
(outside the service area within the U.S.)		In-network benefits for up to 9 monthsIn-network benefits for up to 9 monthsIn-network benefits for up to 9 months
Annual plan out-of-pocket maximum$5,000$3,000$3,000


What else do I need to know before choosing this plan?

  • Is your doctor in the network?
    In Minnesota, 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)Leaving this site icon to learn about prescription drug coverage options.
  • Does this plan offer additional benefits, discounts or services?
    Yes, learn about other features of this plan.
  • Eligibility
    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

How can I learn more?

You can also contact Blue Cross for plan information or to learn how to enroll: (651) 662-9949 or toll free 1-855-579-7658 or TTY 1-866-582-1158, daily from 8 a.m. to 8 p.m. Central Time. Services representatives and licensed sales representatives area available when you call this number.

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, 2013. 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 October 1, 2011
H2461_122011_J02 CMS Approval 12/21/2011

Plans & Services: Medicare