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  BLUE MEDICARE HMO
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 BLUE MEDICARE PPO
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Enhanced plan Medical-only plan Standard plan Enhanced plan Enhanced Plus plan
Additional monthly premium1 $67.40 $0 $0 $76.80 $107.90
Provider choice
  • In-network benefits only
  • Must use a network provider
  • In-network benefits only
  • Must use a network provider
  • In-network benefits only
  • Must use a network provider
  • In- and out-of-network benefits
  • Choose any network physician for less cost
  • Choose an out-of-network physician for higher cost
  • Choose any network or out-of-network physician at the same cost
Primary care physician office visits
  • $15 copayment for in-network visits only
  • $5 copayment for in-network visits only
  • $15 copayment for in-network visits only
  • $15 copayment for in-network visits
  • Pay 20% coinsurance for out-of-network visits3
  • $10 copayment for in-network visits
  • Pay $20 coinsurance for out-of-network visits
Inpatient hospital benefits
  • $350 copayment for each Medicare-covered stay
  • $350 copayment for each Medicare-covered stay
  • $700 copayment for each Medicare-covered stay
  • $350 copayment for each Medicare-covered stay
  • $350 copayment for each Medicare-covered stay
Medicare prescription drug benefit2
  • Includes our enhanced drug benefit
  • No deductible
  • Generics covered in coverage gap
None
  • Includes standard drug benefit
  • No deductible
  • No coverage in the coverage gap
  • Includes our enhanced drug benefit
  • No deductible
  • Generics covered in coverage gap
  • Includes our enhanced drug benefit
  • No deductible
  • Generics covered in coverage gap
Features
  • Includes our most robust medical benefits
  • Prescription drug coverage offered
  • Includes our most robust medical benefits
  • Basic medical and standard prescription drug coverage
  • Freedom to visit out-of-network providers
  • Freedom to visit out-of-network providers at generally the same benefit level as in-network providers
  BLUE MEDICARE HMO
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 BLUE MEDICARE PPO
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Further details of coverage, limitations and exclusions, and terms under which the policy can be continued in force, see your agent or write to the company.

Benefits, premium and/or copayment/coinsurance may change on January 1, 2010. Please contact Blue Cross and Blue Shield of North Carolina for more details.

Blue Medicare HMO and Blue Medicare PPO plans are offered by PARTNERS National Health Plans of North Carolina, Inc. (PARTNERS), a subsidiary of Blue Cross and Blue Shield of North Carolina (BCBSNC). PARTNERS is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. Plans are administered by BCBSNC. BCBSNC and PARTNERS do not discriminate based on color, gender, religion, national origin, age, race, disability, handicap, sexual orientation, genetic information, source of payment or health status as defined by the Centers for Medicare & Medicaid Services (CMS). All qualified Medicare beneficiaries may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or another third party. BCBSNC and PARTNERS are independent licensees of the Blue Cross and Blue Shield Association.

1 As a member of one of the Blue Medicare HMO or Blue Medicare PPO, you must continue to pay the Medicare B premium in addition to your plan premium.

2 Formulary applies. Refer to the Guide to Medicare Prescription Drug Coverage for details on the Enhanced and Standard packages.

3 Except for emergency or urgent care, you may pay more for out-of-network provider services.

The information on this page is current as of 10/16/08.

© , Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.