2018 Medicare Advantage PPO a Medicare Advantage plan from Blue Cross Blue Shield of Michigan

Medicare Plus BlueSM is a PPO plan with a Medicare contract. Enrollment in Medicare Plus Blue depends on contract renewal.

Alabama, Florida and Indiana

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Joining is EASY as 1-2-3

Review this packet. If you have questions, call 1-877-336-0377 8:30 a.m. to 8 p.m. Eastern time, Monday through Friday.

Enroll by calling 1-866-637-7555, 8:30 a.m. to 4:30 p.m. Eastern time, Monday through Friday.

TTY users should call 711.

Begin enjoying the confidence of being covered by

Medicare Plus Blue Group PPO along with our enhanced benefits.

ContentsSavings with Blue Cross Medicare Advantage PPO ...............................................................2

6 reasons Blue Cross Medicare Advantage PPO makes sense ..............................................4

ABCs of Medicare .....................................................................................................................6

Becoming eligible for Medicare ..............................................................................................7

Summary of frequently used benefits and cost sharing .........................................................8

Understanding important terms ..............................................................................................9

Frequently asked questions ...................................................................................................14

Ready to join? Heres what happens next .............................................................................17

Contact information ............................................................................................... Back cover

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Look at the money you can keep in your pocket with Medicare Advantage PPO from Blue Cross

*Savings may vary based on when you enroll and how much you use your coverage.

**In network deductible is limited to $245 for specific in network services that dont require a copay.

Monthly contribution

Deductible

Out-of-pocket maximum

(including deductible and coinsurance

amounts)

Office visit (primary care)

Office visit (specialist)

Emergency care visit

Urgent care visitLaboratory and pathology tests

Inpatient hospital services

Outpatient surgery

Skilled nursing

Physical therapy

SilverSneakers Fitness membership

Your Medicare Advantage PPO option

$0 per person $245 in network** $630 in network

$20 per visit in network

(not subject to Part B deductible)

$25 per visit in network

(not subject to Part B deductible)

$50 copay $25 copay 100% covered10% coinsurance

after plan deductible is met

Included at no cost with your coverage

Traditional Care Network

$17 per month ($204 per year) $400 in network $800 in network

You pay 20% of covered charges after your Medicare

Part B annual deductible is met

You pay 20% of covered charges after your Medicare

Part B annual deductible is met

$125 copay $50 copay10% coinsurance

after plan deductible is met

10% coinsurance after plan deductible

is metNot a benefit

Savings $17 per month ($204 per year*) $155

* $170*$20 copay vs. 20%

after your Part B deductible*

$25 copay vs. 20%

after your Part B deductible*

$75 per visit* $25 per visit*

100% covered vs. 10% coinsurance

after your Traditional Care Network deductible

is met*

Lower deductible* saves you money

Fitness membership (at no extra cost)

Physician office servicesDeductible, copayments, coinsurance and dollar maximums

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Monthly contribution

Deductible

Out-of-pocket maximum

(including deductible and coinsurance

amounts)

Office visit (primary care)

Office visit (specialist)

Emergency care visit

Urgent care visitLaboratory and pathology tests

Inpatient hospital services

Outpatient surgery

Skilled nursing

Physical therapy

SilverSneakers Fitness membership

Your Medicare Advantage PPO option

$0 per person $245 in network** $630 in network

$20 per visit in network

(not subject to Part B deductible)

$25 per visit in network

(not subject to Part B deductible)

$50 copay $25 copay 100% covered10% coinsurance

after plan deductible is met

Included at no cost with your coverage

Traditional Care Network

$17 per month ($204 per year) $400 in network $800 in network

You pay 20% of covered charges after your Medicare

Part B annual deductible is met

You pay 20% of covered charges after your Medicare

Part B annual deductible is met

$125 copay $50 copay10% coinsurance

after plan deductible is met

10% coinsurance after plan deductible

is metNot a benefit

Savings $17 per month ($204 per year*) $155

* $170*$20 copay vs. 20%

after your Part B deductible*

$25 copay vs. 20%

after your Part B deductible*

$75 per visit* $25 per visit*

100% covered vs. 10% coinsurance

after your Traditional Care Network deductible

is met*

Lower deductible* saves you money

Fitness membership (at no extra cost)

Emergency medical care

Outpatient diagnostic services

Hospital and other services

Beyond original Medicare

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There are no referrals required

You can visit the hospital or doctor of your choice, including specialists.

Tivity Health is an independent corporation retained by Blue Cross Blue Shield of Michigan to provide health and fitness services to its Medicare Plus BlueSM PPO members. Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries. 2017 Tivity Health, Inc. All rights reserved.

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6 reasons Blue Cross Medicare Advantage PPO makes sense

More than 89,000 of your fellow UAW Trust retirees are currently enrolled in the Medicare Advantage PPO plan from Blue Cross. Heres why:

Low in-network deductibleYour plan starts paying a share of the cost sooner, so you save money.

Low copayments on emergency and urgent care visits Whether youre traveling across the country or around the world, emergency and urgent care coverage travels with you.

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4The SilverSneakers Fitness program Your Medicare Advantage PPO plan includes a free fitness center membership at more than 13,000 locations across the U.S. For more information about SilverSneakers, visit www.silversneakers.com or call 1-866-584-7352. TTY users call 711. You must use SilverSneakers facilities to obtain this benefit.

When enrolled in the Blue Cross Medicare Advantage plan, you pay no monthly contribution to the Trust.Thats a savings of $204 per year.

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Confidence comes with every card One ID card

One comprehensive health care plan

One explanation of benefits statement

One dedicated Customer Service team

Questions? Call 1-877-336-0377, 8:30 a.m. to 8 p.m. Eastern time, Monday through Friday. Or visit us online at www.bcbsm.com/UAWTrust.

6 Dont leave your money behindWhen a Traditional Care Network member transfers to Medicare Advantage PPO during the calendar year, you get credit for what youve already paid toward your TCN Plan*:

TCN MA

Deductible up to $245 per person

Out-of-pocket maximum up to $630 per person

* This applies only to members transferring from the TCN plan to Medicare Advantage PPO. 5

The ABCs of Medicare

Original Medicare

Part AMedicare Part A helps cover an inpatient stay at the hospital, skilled nursing facility or rehabilitation facility. Here are just a few of the costs that are covered through Part A:

A semi-private hospital room

Drugs, medical supplies and medical equipment as an inpatient

Lab tests, X-rays and radiation treatment as an inpatient

Operating room and recovery room services

Some blood transfusions in a hospital or skilled nursing facility

Rehabilitation services, such as physical therapy through home health care

Medicare Part B goes hand-in-hand with Part A. It covers the cost of doctor visits including an annual wellness exam and other medical services. You can count on it for expenses, such as:

Visits to your doctor and outpatient medical services

Emergency services

Clinical laboratory services, such as blood and urine tests

Some preventive care, including flu shots

Some preventive screenings, such as mammograms, colorectal screenings and prostate cancer screenings

When enrolled in the Medicare Advantage plan, youll still need to pay your Part B premium.

Original Medicare

Part A

Original Medicare

Part B

Part Cadds extra

benefits

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In most cases, if you already receive Social Security, youll be automatically enrolled in Medicare Part A and Part B. You may contact the Social Security Administration to verify your enrollment.

If you need to enroll in Medicare Parts A and B, follow these three easy steps:

Call the Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m. Monday through Friday for an appointment. TTY users call 1-800-325-0778.

Apply online at the official website: ssa.gov/medicareonly/

Visit in person at your local Social Security office.

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