Platinum Blue (Cost) – flexible, lower-cost plan options
Eligibility
Platinum Blue(SM) is a Medicare-approved Cost plan. You may enroll in Platinum Blue if you are entitled to coverage under Medicare Part A and enrolled in Medicare Part B (or enrolled in Medicare Part B only) and reside in Minnesota. Refer to important Platinum Blue disclaimers for additional details.
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 | $29 | $79 | $99 |
| Annual deductible | No deductible | No deductible | No deductible |
| 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 any 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 |
Travel coverage
(outside the service area and within the U.S.) | Coverage for up to 9 months | Coverage for up to 9 months | Coverage 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
Pair this medical plan with MedicareBlue(SM) Rx (PDP), a stand-alone prescription drug plan with a Medicare contract. Three plan options offer different levels of cost-sharing with access to a nationwide network of pharmacies.
- Does this plan offer additional benefits, discounts or services?
Yes, learn about other features of this plan.
Download detailed information
You can also contact Blue Cross directly for more information or to learn how to enroll: 1-877-662-BLUE (2583) or TTY 1-866-582-1158, daily from 8 a.m. to 8 p.m. Central Time. You have the option to speak with a licensed sales representative when you call this number.
Plans are available to residents of the service area. You must continue to pay your Part B premium, if not otherwise paid for under Medicaid or by another third party. 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, 2011. The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; 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 2010
H2461_052510_F01 CMS 060710
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