Medigap basics
Blue Cross Blue Shield of Michigan (BCBSM) offers Legacy Medigap insurance policies for Plans A and C only. Other Michigan insurance carriers may offer other or additional plans, but Medigap plans can be sold in only 10 standard plans plus one high-deductible plan. (Plans A-D, F, G, K, L, M and N. Plans E, H, I and J are no longer available for sale.) Every insurer must make Plan A available. Plan A covers basic benefits:
- Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end
- Medical expenses: Part B coinsurance (20 percent of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L and N require the insured to pay a portion of Part B coinsurance or copayments.
- Blood: First three pints of blood each year
- Hospice: Part A coinsurance.
BASIC BENEFITS: For Plans A - D, F, G, K, L, M and N
| Plan | A | B | C | D | F/F* | G |
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| Skilled Nursing | |
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| Part A Deductible | |
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| Part B Deductible | |
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| Part B Excess | 100% | 100% | ||||
| Foreign Travel Emergency | $250 deductible | $250 deductible | $250 deductible | $250 deductible |
* Plan F also has an option called a high-deductible plan F. This high-deductible plan pays the same benefits as Plans F after one has paid a calendar year ($2,000 in 2010) deductible. Benefits from high-deductible Plan F will not begin until out-of-pocket expenses exceed ($2,000 in 2010). Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan's separate foreign travel emergency deductible.
Basic Benefits for Plans K, L, M and N include similar services as plans A-D, F and G, but cost-sharing for the basic benefits is at different levels.
| Plan | K | L | M | N |
| Basic Benefits | 100% of Part A hospitalization coinsurance and preventive care | 100% of Part A hospitalization coinsurance and preventive care | 100% of Part A hospitalization coinsurance, including hospice | 100% of Part A hospitalization coinsurance, including hospice |
| 50% Hospice cost-sharing | 75% Hospice cost-sharing | |||
| 50% of Medicare-eligible expenses for the first three pints of blood | 75% of Medicare-eligible expenses for the first three pints of blood | 100% of Medicare-eligible expenses for the first three pints of blood | 100% of Medicare-eligible expenses for the first three pints of blood | |
| 50% Part B coinsurance | 75% Part B coinsurance | Part B copays up to $20 for office visits and up to $50 for emergency room visits | ||
| Skilled nursing coinsurance | 50% skilled nursing facility coinsurance | 75% skilled nursing facility coinsurance | 100% skilled nursing facility coinsurance | 100% skilled nursing facility coinsurance |
| Part A Deductible | 50% Part A deductible | 75% Part A deductible | 50% Part A deductible | 50% Part A deductible |
| Part B Deductible | ||||
| Part B Excess | ||||
| Foreign Travel Emergency | $250 deductible | $250 deductible | ||
| $4,620 out of pocket Annual Limit** | $2,310 out of pocket Annual Limit** |
** Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called "Excess Charges." You will be responsible for paying excess charges. The out-of-pocket annual limit will increase each year for inflation. The value here is for plan year 2010.
Choose a Legacy Medigap plan option that meets your needs
Please download the Legacy Medigap plan brochure (PDF 599KB) for a detailed outline of coverage.
Download the Legacy Medigap plan brochure (PDF 599KB) to compare benefits and premiums among policies, certificates of coverage and contracts and premiums offered by Blue Cross Blue Shield of Michigan and other plans. Visit the Premiums page for more information about plan premiums.
The outline of coverage does not give all the details of Medicare coverage. This outline shows benefits and premiums of policies sold for effective dates on or after June 1, 2010. Policies sold for effective dates prior to June 1, 2010, have different benefits and premiums. Plans E, H, I, and J are no longer available for sale. For information about your Medicare Part A and Part B coverage, contact your local Social Security office or consult Medicare & You. Medicare benefits are subject to change. Please consult the latest Choosing a Medigap policy: Guide to Health Insurance for People with Medicare.
Note: The Legacy Medigap plan may not fully cover all of your medical costs. When you receive covered services from a provider that does not accept Medicare assignment, you are responsible for the difference between the provider's charge and the Medicare-approved amount, plus any deductible or coinsurance amounts required by the Legacy Medigap policy you select.
Once enrolled in Legacy Medigap, we'll send you a member ID card. The following is only an outline describing the most important features of Blue Cross Blue Shield of Michigan's Legacy Medigap certificate of coverage. The certificate of coverage is your contract with Blue Cross Blue Shield of Michigan. You must read the certificate to understand all of the rights and duties of both you and BCBSM. For more information about Legacy Medigap coverage, call 1-877-469-2583. TTY users should call 1-800-481-8704.
Like Medicare, Legacy Medigap coverage is accepted nationwide and the plan is easy to use. There are no provider networks or referrals: Just use any health care provider that accepts Medicare. Simply present your Legacy Medigap ID card along with your red, white and blue Medicare health insurance card whenever you receive health care services. We'll coordinate payment with Medicare and your health care providers. In most cases, you'll never have to bother with claim filing or paperwork.
