Compare 2010 Blue Medicare PPO benefits

	Enhanced plan	Enhanced Freedom plan
Additional monthly premium^1,2	$97.60	$147.50
Provider choice	In- and out-of-network benefits Choice of any network physician for less cost Choice of an out-of-network physician for higher cost	Choice of any network or out-of-network physician at generally the same cost
Primary care physician office visits	$20 copayment for in-network visits Pay 20% coinsurance for out-of-network visits³	$20 copayment for in-network visits Pay $40 for out-of-network visits³
Inpatient hospital benefits	$700 copayment for each in-network Medicare-covered hospital stay 20% of the cost for each out-of-network hospital stay	$700 copayment for each in-network Medicare-covered hospital stay $700 copayment for each out-of-network hospital stay
Medicare prescription drug benefit⁴	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	Freedom to visit out-of-network providers	Freedom to visit out-of-network providers at generally the same benefit level as in-network providers

For information on how to enroll as well as important information regarding enrollment, refer to our How to Enroll page.

Compare Blue Medicare HMO and Blue Medicare PPO
View a side-by-side comparison of Blue Medicare HMO and Blue Medicare PPO.

To view PDF documents you need Adobe Acrobat Reader.

Benefits, premium and/or copayment/coinsurance may change on January 1, 2011. Please contact Blue Cross and Blue Shield of North Carolina for more details.

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 descision about your coverage. This is an advertisement; for more information contact the plan.

Blue Cross Blue Shield of North Carolina (BCBSNC) is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. BCBSNC does 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 is an independent licensee of the Blue Cross and Blue Shield Association.

The SilverSneakers program is provided by Healthways, Inc., a third-party vendor independent of BCBSNC. The program is available only to members covered under Blue Medicare HMO or Blue Medicare PPO plans. BCBSNC is not liable in any way for the services received; results are not guaranteed. Decisions regarding medical care should be made with the advice of a doctor. ^®, SM Marks of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina. ^®1 Mark of Healthways, Inc.

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

2 If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for the change to take effect, and you will be responsible for premiums during that time.

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

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

The information on this page is current as of 05/01/2010.