How Medicare Supplement Plans work Questions (800) 790-6409

Medicare pays the Medicare-approved amount first, then your Medicare Supplement plan pays all or part of the balance, depending on which plan you choose. For example, let’s assume you have already met your yearly Medicare Part B deductible ($135), and the physician charge is $2,000 for a Medicare-covered service. The following example shows how Medicare Supplement plans work:

The total cost of your physician’s service is: $2,000

The Medicare-approved amount is: $1,800

Generally, Medicare pays 80% of the approved amount: -$1,440

Medicare Supplement plans pay up to the remaining 20%: Up to $360

If you enroll in Plans A, B, C, or D:

You pay nothing for Medicare-approved physician services, as long as your physician agrees to provide service and accept Medicare assignment charges for the services provided. This means you don’t have to worry about bills for excess charges. If you physician does not accept Medicare assignment, however, you must pay the “excess charges,” which are the difference between the total amount and the Medicare-approved amount. Currently, physicians who don’t accept Medicare assignment cannot bill for more than 115% of Medicare-approved charges. In this example, since the physician charged more than the Medicare-approved amount, you would pay $200 ($2,000-$1,800).

If you enroll in Plan F or J:

You pay nothing for Medicare-approved physician services even if you physician does not accept Medicare assignment, because Plans F and J include coverage for 100% of excess charges. Plans F and J cover the difference, or the “excess charges” (if any) between the amount charged by you physician and the Medicare-approved amount. In this example, the Medicare Supplement plan would pay $360 if the provider accepts assignment, and $560 if the provider does not accept assignment. You pay $0 in either scenario, because the plan pays both the 20% and any applicable excess charges.

Blue Shield Medicare Supplement / Medigap Plans Available include:
Blue Shield of California Plan A Medicare Supplement / Medigap A Plan
Blue Shield of California Plan B Medicare Supplement / Medigap B Plan
Blue Shield of California Plan C Medicare Supplement / Medigap C Plan
Blue Shield of California Plan D Medicare Supplement / Medigap D Plan
Blue Shield of California Plan F Medicare Supplement / Medigap F Plan
Blue Shield of California Plan G Medicare Supplement / Medigap G Plan
Blue Shield of California Plan J Medicare Supplement / Medigap J Plan
Blue Shield of California Plan K Medicare Supplement / Medigap K Plan

For Assitance Please call (800) 790-6409

Medicare Supplement Coverage

One of our Medicare Supplement plans is likely to be the right plan for you—and it’s from the right company. After all, we’ve been in the healthcare business for more than 65 years. Blue Shield’s Medicare Supplement plans offer you the freedom to choose any doctor, specialist, hospital, or other provider that accepts Medicare. In other words, you’re not limited to a network!

Medicare Supplement coverage can only be sold in 12 standard plans plus two high-deductible plans. The following chart compares the benefits included in each plan. Every company that offers Medicare Supplement plans must offer Plan A. Some plans may not be available in California.

Use the chart on the following page to compare benefits among all the Medicare Supplement plan options. Blue Shield offers Plans A, B, C, D, F, G, J, and K, shown in darker gray on the chart.

Blue Shield’s Plans A, B, C, D, F, G, J, and K meet the requirements for Medicare’s Supplement plans established by the federal government, the state of California, and the National Association of Insurance Commissioners (NAIC).

For additional information concerning covered benefits, contact the Health Insurance Counseling and Advocacy Program (HICAP) or your agent. HICAP provides health insurance counseling for California senior citizens. Call the HICAP toll-free telephone number, (800) 434-0222, for a referral to your local HICAP office. HICAP is a service provided free of charge by the state of California.

FREEDOM OF CHOICE

You’ve earned the right to have a choice of the doctor or hospital you want to use, and we respect that right. Our ClaimFree Standard Plan A Medicare Supplement Plan/Medigap A Plan, BLUE SHIELD Senior Classic C Medicare Supplement Plan/Medigap C Plan, BLUE SHIELD Senior Classic F Medicare Supplement Plan/Medigap F Plan, BLUE SHIELD Senior I Medicare Supplement Plan/Medigap I Plan and BLUE SHIELD Senior Classic J Medicare Supplement Plan/Medigap J Plan offer you access to the Prudent Buyer network, as well as any Medicare-participating physician and any Medicare-approved hospital in the state. You are covered whether or not you use a Prudent Buyer Physician.

PRUDENT BUYER NETWORK OF PARTICIPATING DOCTORS AND HOSPITALS

The Prudent Buyer network offers you the choice of a wide variety of physicians and hospitals conveniently located throughout the state to help you with all of your health care needs. This is the largest network in California, with over one half of all physicians and hospitals in the state being Participating Prudent Buyer Providers. Nearly 50,000 physicians and more than 300 hospitals are Participating Prudent Buyer Providers, so there’s a good chance that your current physician or hospital is already a member of our network.

PROTECTION AGAINST EXCESS CHARGES

Under Part B of Medicare, you could have out-of-pocket costs if your physician or medical supplier does not accept assignment of your Medicare claim and charges more than Medicare’s approved amount. The difference to be paid is called the ‘excess charge.’
BLUE SHIELD Senior Classic F Medicare Supplement Plan/Medigap F Plan, BLUE SHIELD Senior Classic I Medicare Supplement Plan/Medigap I Plan and BLUE SHIELD Senior Classic J Medicare Supplement Plan/Medigap J Plan can save you the expense and worry about paying significant out-of-pocket costs because of gaps in Medicare. When you utilize BLUE SHIELD of California’s Prudent Buyer network, your doctor’s charges for Medicare’s covered services are paid in full, and most plans also cover the Medicare Part B deductible.* Even if you receive medical services from a provider that is not a member of the Prudent Buyer network, your doctor’s charges for Medicare’s covered services are still paid in full, except in limited circumstances, including emergency care.

* BLUE SHIELD Senior Classic I Medicare Supplement Plan/Medigap I Plan covers ‘excess charges’ but not the Medicare Part B $131 deductible.

CLAIMFREE SERVICE

You may never have to fill out another claim form ever again. BLUE SHIELD of California has created a way to put an end to the frustration caused by burdensome and tedious claim forms. It’s called ClaimFree service, and we are the only health carrier in the state that provides you with this worry-free automatic claims payment service for both Parts A and B of Medicare.

The way it works is simple. When providers bill Medicare, a computerized display of the information is automatically sent to BLUE SHIELD of California for processing. We then pay your doctor or hospital directly. This results in your medical bills being processed faster and more accurately.