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Welcome!
2010
Excellus BlueCross BlueShield
Fall Member Meeting
Excellus BlueCross BlueShield contracts with the Federal
Government and is a Medicare Advantage Organization with a
Medicare contract.
A nonprofit independent licensee of the Blue Cross Blue Shield Association
Our Vision
“…to be a best in class Medicare Program,
providing Medicare beneficiaries with a
range of products and services that meet
their needs for health coverage at an
affordable price.”
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2010 Highlights
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
As the health care landscape evolves,
Excellus BlueCross BlueShield continues to provide
low cost, benefit-rich Medicare health plans

No Change To Most Benefits

Valuable Extras
Why Excellus BlueCross BlueShield?
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
Power of Blue – One of the most recognized health care insurers

More than 3,000 participating providers

In business for over 70 years

Commitment to serving our local communities
Agenda
 Plan Changes
 What’s New?
 Valuable Extras
 What Do You Need to Do?
 Questions
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HMO vs. PPO
You are eligible to join a Medicare Advantage Plan if you have Medicare
Part A and B, live in our service area, and don’t have end stage renal disease.
HMO
PPO
Health Maintenance Organization
Preferred Provider Organization
Primary Care Physician (PCP) is required.
Primary Care Physician (PCP) not required
Referrals required to see specialists
No referrals required to see specialists
Must use In-Network providers
Can use In-Network & Out-of-Network
providers*
(You must receive all routine care from plan providers)
(Out-of-pocket costs may be higher when you use an Out-ofNetwork provider, except in cases such as emergency care,
urgently needed care, or out-of-area renal dialysis)
*Excellus BlueCross BlueShield provides reimbursement for all covered
benefits regardless of whether they are received In-Network, as long as they
are medically necessary.
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Medicare Advantage Plan Options
 HMO Plans
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Medicare
Medicare
Medicare
Medicare
Blue
Blue
Blue
Blue
Choice
Choice
Choice
Choice
ValueSM (HMO)
Value PlusSM (HMO)
OptimumSM (HMO)
PlatinumSM (HMO)
 PPO Plan
 Medicare Blue PPOSM Plan 201 (PPO)
For full information on Medicare Blue Choice and/or Medicare Blue PPO benefits, call our Customer Service
Department at 1-877-883-9577 for Medicare Blue Choice or 1-866-846-8643 for Medicare Blue PPO , TTY/TDD
1-800-421-1220 Monday – Friday, 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are
available weekends from 8:00 a.m. – 8:00 p.m.
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Our contract with CMS is renewed annually and the availability of coverage beyond the
current contract year is not guaranteed. Benefits, formulary, pharmacy network,
premium and/or copayments/coinsurance may change on January 1, 2011. Please
contact Excellus BlueCross BlueShield for details.
Medicare Blue Choice ValueSM (HMO)
No changes to the following benefits or cost-sharing in 2010:
PCP Office Visit
Specialist Office Visit
Ambulance Services
Emergency Room
Inpatient Hospital
Outpatient Hospital
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Physical Therapy
Skilled Nursing Facility (SNF)
Chiropractic
$650 GoGetters® Fitness Benefit
…and more!
Medicare Blue Choice ValueSM (HMO)
Monthly Premium
2009
2010
$0*
$5.50*
* You must continue to pay your Medicare Part B premium if not
otherwise paid for under Medicaid or by another third party.
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Medicare Blue Choice ValueSM (HMO)
Benefit
2009
2010
Outpatient Mental Health Care
(per visit)
50% coinsurance
45% coinsurance
Durable Medical Equipment
30% coinsurance
20% coinsurance
Prosthetic Devices
30% coinsurance
20% coinsurance
Diabetic Supplies
30% coinsurance
20% coinsurance
Part D Deductible
$175
$150
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Medicare Blue Choice Value PlusSM (HMO)
No changes to the following benefits or cost-sharing in 2010:
PCP Office Visit
Specialist Office Visit
Ambulance Services
Emergency Room
Inpatient Hospital
Outpatient Hospital
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Physical Therapy
Skilled Nursing Facility (SNF)
Chiropractic
$650 GoGetters® Fitness Benefit
…and more!
Medicare Blue Choice Value PlusSM (HMO)
Monthly Premium
2009
2010
$35*
$41*
* You must continue to pay your Medicare Part B premium if not
otherwise paid for under Medicaid or by another third party.
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Medicare Blue Choice Value PlusSM (HMO)
Benefit
2009
2010
Outpatient Mental Health Care
(per visit)
50% coinsurance
45% coinsurance
Durable Medical Equipment
30% coinsurance
20% coinsurance
Prosthetic Devices
30% coinsurance
20% coinsurance
Diabetic Supplies
30% coinsurance
20% coinsurance
Part D Deductible
$175
$150
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Medicare Blue Choice OptimumSM (HMO)
No changes to the following benefits or cost-sharing in 2010:
PCP Office Visit
Specialist Office Visit
Ambulance Services
Emergency Room
Inpatient Hospital
Outpatient Hospital
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Physical Therapy
Skilled Nursing Facility (SNF)
Chiropractic
$650 GoGetters® Fitness Benefit
…and more!
Medicare Blue Choice OptimumSM (HMO)
Monthly Premium
2009
2010
$90*
$101*
* You must continue to pay your Medicare Part B premium if not
otherwise paid for under Medicaid or by another third party.
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Medicare Blue Choice OptimumSM (HMO)
Benefit
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2009
2010
Durable Medical Equipment
25% coinsurance
20% coinsurance
Prosthetic Devices
25% coinsurance
20% coinsurance
Diabetic Supplies
30% coinsurance
20% coinsurance
Medicare Blue Choice PlatinumSM (HMO)
No changes to the following benefits or cost-sharing in 2010:
PCP Office Visit
Specialist Office Visit
Ambulance Services
Emergency Room
Inpatient Hospital
Outpatient Hospital
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Physical Therapy
Skilled Nursing Facility (SNF)
Durable Medical Equipment (DME)
Chiropractic
$650 GoGetters® Fitness Benefit
…and more!
Medicare Blue Choice PlatinumSM (HMO)
Monthly Premium
2009
2010
$45*
$61*
* You must continue to pay your Medicare Part B premium if not
otherwise paid for under Medicaid or by another third party.
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Medicare Blue Choice PlatinumSM (HMO)
Benefit
Diabetic Supplies
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2009
2010
30% coinsurance
20% coinsurance
Medicare Blue PPOSM Plan 201 (PPO)
No changes to the following benefits or cost-sharing in 2010:
PCP Office Visit
Specialist Office Visit
Ambulance Services
Emergency Room
Inpatient Hospital
Outpatient Hospital
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Physical Therapy
Skilled Nursing Facility (SNF)
Chiropractic
$650 GoGetters® Fitness Benefit
…and more!
Medicare Blue PPOSM Plan 201 (PPO)
Monthly Premium
2009
2010
$25*
$36*
* You must continue to pay your Medicare Part B premium if not
otherwise paid for under Medicaid or by another third party.
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Medicare Blue PPOSM Plan 201 (PPO)
Benefit
2009
2010
Radiology Services (per visit)
10% coinsurance In-Network
20% coinsurance
In-Network
Outpatient Mental Health Care
(per visit)
50% coinsurance In-Network
45% coinsurance
In-Network
Durable Medical Equipment
30% In-Network
40% Out-of-Network
coinsurance
20% In-Network
30% Out-of-Network
coinsurance
Prosthetic Devices
30% In-Network
40% Out-of-Network
coinsurance
20% In-Network
30% Out-of-Network
coinsurance
Seasonal flu/pneumonia vaccines
30% Out-of-Network
Covered in full
Out-of-Network
Diabetic Supplies
30% coinsurance In-Network
20% coinsurance
In-Network
Part D Deductible
$175
$150
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Medicare Prescription Drug Plan (Part D)
4 Coverage Phases
Catastrophic Coverage begins
when you or others on your
behalf have spent $4,5501.
No coverage when total drug
spend exceeds $2,8301 until your
true out of pocket spending
reaches $4,5501.
Initial Coverage starts after you
have met your deductible, if
applicable, and continues until
your total drug costs reach
$2,830.1
You must pay your deductible
(if applicable) before you start
getting your prescription
coverage.
1 Coverage
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2 Benefits,
Catastrophic Coverage
You pay $2.50 for
generics and
$6.30 for brand
name drugs, or
5% of the price
(whichever is
greater)
Excellus BlueCross BlueShield pays the
balance
Coverage Gap
All costs are out-of-pocket
You Pay
Initial Coverage Period
Your copays/coinsurance
Excellus BlueCross BlueShield
pays the balance
Deductible is out-of-pocket
$0 or $1502
Out Of Pocket
Medicare Drug Benefit
limits for all phases of the Part D benefit change annually.
formulary, pharmacy network, premium, copayment/coinsurance may
change on January 1, 2011. Contact Excellus BlueCross BlueShield for details.
Medicare Prescription Drug Plan (Part D)
Formulary Changes
• Review the drugs you are taking
• Consult with your doctor if your drug will no longer be covered.
Network
• About 60,000 pharmacies nationwide
• Retail, mail order, long-term care, home infusion, Indian/Tribal/Urban
pharmacies included
• For additional information regarding our pharmacy network, quantity
limits, and mail order prescription drug service, call: 1-877-883-9577
TTY/TDD 1-800-421-1220 Monday-Friday 8:00 a.m. – 8:00 p.m. From
November 15 – March 1 representatives are also available weekends from
8:00 a.m. – 8:00 p.m.
• You may write us at: Excellus BlueCross BlueShield, PO Box 546, Buffalo,
NY 14201
You must use network pharmacies to access your prescription drug benefit, except under
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Medicare Prescription Drug Plan (Part D)
You may be able to get Extra Help to pay for your
prescription drug premiums and costs.
 To see if you qualify for getting Extra Help, call:
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•
1-800-MEDICARE (1-800-633-4227), TTY/TDD users should
call 1-877-486-2048, 24 hours a day/7 days a week;
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The Social Security Administration at
1-800-772-1213 between 7:00 a.m. – 7:00 p.m., Monday
through Friday, TTY/TDD users should call 1-800-325-0778;
or
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Your State Medicaid office.
Medicare Prescription Drug Plan (Part D)
People with limited incomes may qualify for Extra Help to pay for their
prescription drug costs. If eligible, Medicare could pay for:
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seventy-five percent of drug costs including monthly prescription drug premiums,
annual deductibles, and
coinsurance.
Additionally, those who qualify will not be subject to the coverage gap or a
late enrollment penalty.
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Many people are eligible for these savings and don’t even know it.
For more information about this Extra Help, contact your local Social Security office or
call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY
users should call 1-877-486-2048.
Summary of 2010 Benefit Changes
 No Change To Most Benefits
 Valuable Extras
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Health and Wellness
 GoGetters® Fitness Benefit
• Up to $650 per calendar year*
• Qualified fitness facility membership fees
• Qualified weight management program
membership fees
• Can be used in conjunction with Blue365
* This benefit does not cover any ancillary services or
items that are not part of a membership fee.
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What’s New
Blue365 offers access to savings and discounts on items that
members may purchase directly from independent vendors. Blue365
may also be used in conjunction with the GoGetters® Benefit.
 Fitness- save on membership, monthly fees and other services at Gold’s
Gym®, Curves®, Snap FitnessTM and Global FitTM
 Nutrition- Save on programs, products and consultations at eDiets®,
Kronos Optimal Health® and Jenny Craig®
 Elective procedures- Save on vision products and services at Davis
Vision®, QualSight LASIK ®, LasikPlus® and TruVisionTM
 Hearing aids- Save on products from BeltoneTM and TruHearing
The products and services described above are neither offered nor guaranteed under
our contract with the Medicare program. In addition, they are not subject to the
Medicare appeals process. Any disputes regarding these products and services may be
subject to the Excellus BlueCross BlueShield grievance process.
Note: Not all vendors that have provided discounts for Blue365 are qualified fitness
facilities or weight management programs for purposes of our GoGetters benefit
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.
What’s New
Enhanced Web Tools
 Side by side comparisons of:
 Your plan options &
 Estimated out-of-pocket costs.
 2010 plan changes
 Learn more about cost-cutting options
 Research health topics
 Change your doctor
 Request ID cards
 Access health coaching information
www.excellusbcbs.com/medicare
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Valuable Extras
 Medicare Dedicated Customer Service Unit
 Knowledgeable and friendly staff dedicated to
answering any questions you may have timely,
accurately, and professionally.
 24-hour Personal Health Coaching Line
 Provides education and programs on nutrition,
weight management and much more.
 Disease & Case Management
 Clinical staff work with you to make informed
choices on your health care and prescriptions
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What To Expect
 Whether changing your coverage or not, you will
receive new:
 ID cards
 GoGetters® card (if you already have a card that
you’re using for this benefit)
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What Do You Need To Do?
 If you want to stay in your current plan, there is
nothing you need to do.
 If the plan you are in no longer suits your needs, we
have many other plan options.
 Complete an option transfer form if switching from an
HMO plan to another HMO plan within our organization.
 Complete an application if switching between HMO,
PPO or Medicare Supplement Plans.
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Medicare Advantage Plan Enrollment
Periods
There are only certain times during the year when you may change
or voluntarily end your membership in a Medicare Advantage Plan.
Annual Enrollment Period (AEP)
• Runs from November 15 – December 31, each year
• Can change Medicare Advantage plan or stand-alone
Prescription Drug Plan
• Can add or drop prescription drug coverage
• Can return to Original Medicare
• Enrollment changes take effect on January 1
Open Enrollment Period (OEP)
• Runs from January 1 – March 31, each year
• Can change Medicare Advantage plans
• Cannot add or drop prescription drug coverage
• One opportunity to change to a similar plan
(No-drug plan to no-drug plan – OR – drug plan to drug
plan)
• Enrollment or disenrollment becomes effective the month
after the application is received
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Medicare Advantage Plan Enrollment
Periods
Special Enrollment Period (SEP)
• Change of residence into or out of the service area
• Loss of employer coverage
• Qualify for Low Income Subsidy
To obtain more information regarding Medicare Advantage Plan enrollment periods
you can call our Customer Service Department at 1-877-883-9577 for Medicare
Blue Choice or 1-866-846-8643 for Medicare Blue PPO TTY/TDD 1-800-421-1220
Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1,
representatives are also available weekends 8:00 a.m. – 8:00 p.m.
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How to Contact us
Call us:
• Medicare Blue Choice® (HMO)
• 1-877-883-9577
• Medicare Blue PPOSM
• 1-866-846-8643
• TTY/TDD 1-800-421-1220
Monday – Friday 8:00 a.m. – 8:00 p.m.
From November 15 – March 1, representatives are also available
weekends from 8:00 a.m. – 8:00 p.m.
Write us:
• Excellus BlueCross BlueShield
P.O. Box 546
Buffalo, NY 14201
Visit us on the Web at www.excellusbcbs.com/medicare
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Interested in Receiving Emails?
Fill out our simple form provided by your sales representative or call us to
receive some information such as health and wellness from
Excellus BlueCross BlueShield in your Email!
Call: 1-800-659-1986 (TTY/TDD 1-800-421-1220), Monday – Friday,
8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives
are also available weekends from 8:00 a.m. – 8:00 p.m.
Interested in Becoming an Ambassador?
Ask your Medicare representative about our exciting Ambassador
program.
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We Value Your Opinion
Tell Us How We Are Doing!
Call Our Confidential Voice Message System
1-800-230-7092
24 Hours a day, 7 days a week
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Questions ?
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Thank You!
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