Coverage for Retirees Age 65 or Older
The Retiree Medical Plan is secondary and Medicare is the primary medical and hospital coverage for retirees and dependents age 65 and older who are enrolled in Medicare and no longer covered for medical benefits through an employer's plan. As well as for retirees and dependents enrolled in Medicare under age 65. Although Medicare will provide your primary medical and hospital coverage, Medicare does not pay your claims in full.
Medical and hospital Coverage with the Retiree Medical Plan and Medicare
The Retiree Medical Plan provides medical and hospital coverage through the BlueCross BlueShield (BCBS) Preferred Provider Option (PPO). This plan offers a wide range of benefits and the flexibility to choose any licensed doctor or hospital provider across the country and around the world when you need care.
For Medicare-eligible retirees, the Retiree Medical Plan operates as a supplement to Medicare Part A and Part B coverage. Your care is coordinated with your coverage under Medicare Part A and Part B. Medicare is your primary plan, which means that Medicare determines what it will pay before the Retiree Medical Plan does. Your physician will file your claims with Medicare. BCBS cannot process your claim until it knows the amount that Medicare has covered and paid. All Medicare primary services are covered at 50% of the eligible amount.
Medicare will send you Medicare summary notices, explaining what Medicare has or has not covered. In addition, Medicare may simultaneously send the Medicare information to BCBS for secondary claims processing. Or, your doctor or hospital may send BCBS the Medicare information. If you're concerned whether BCBS is receiving your Medicare information, you should send a copy of your Medicare summary notices to BCBS along with a claim form to ensure that BCBS will process your claim.
Select Key Features
The following represents a partial list of the features the Retiree Medical Plan. Please refer to the Retiree Medical Plan Information brochure for detailed information.
- The annual deductible is $300 for each covered individual.
- This amount will be applied against the amount of the claim unpaid after Medicare pays; not the full amount of the claim approved by Medicare.
- The annual out-of-pocket limit is $1,750 per family. The plan covers 100% after you reach the out-of-pocket limit.
- Overnight hospitalization requires advance BCBS approval. If you do not obtain advance approval, your benefits for that admission will be reduced by $200. In case of an emergency, you or your family member must call BCBS within two days.
- Coverage outside of the United States is provided through BCBS's BlueCard WorldWide Service.
Prescription Drug Coverage with the Retiree Medical Plan
The Retiree Medical Plan provides prescription drug coverage through Express Scripts. All Medicare-eligible retirees, spouses/partners and dependents will be enrolled into a Medicare Part D prescription drug program. Retirees, spouses, and dependents enrolled in the Medicare Part D program will each have a unique member ID number and card.
Select Key Features
The following represents a partial list of the features the Retiree Medical Plan prescription coverage. Please refer to the Retiree Medical Plan Information brochure for detailed information.
- You pay a copayment at the time of purchase depending upon:
- The type of drug - generic, preferred brand, or non-preferred brand
- Which pharmacy the drug is purchased at - in-network or out-of-network
- Where the drug is purchased - a retail pharmacy or through the home delivery/mail order service.
- Prescription drugs are not subject to the medical/hospital $300 annual deductible and do not count towards the $1,750 out-of-pocket limit.