Medicare BlueBasic (PPO)

For Coverage January 1, 2019 to December 31, 2019

Plan Features

  • Dedicated Customer Care department
  • No referrals required
  • Worldwide urgent care and emergency coverage
  • Silver&Fit® Fitness Program (learn more)
    • $25 annual non-refundable fee to enroll in a participating fitness club or exercise center;
    • $10 annual non-refundable fee to enroll in the home fitness program; or
    • $150 annual allowance for out-of-network facilities.

Benefits1

Medical Coverage
Medicare BlueBasic (PPO) provides comprehensive coverage for the health care services you need, including:

  • $5 copay per visit for in-network primary care providers
  • $40 copay per visit for in-network specialists
  • $0 copay for many Medicare-covered preventive services, such as in-network physical exams, smoking cessation and some immunizations
  • $5 copay for in-network chiropractic medical visits
  • Inpatient Hospital Stay
    • $325 copay per day for days 1-5 for each Medicare-covered stay at a network hospital
    • Days 6+ covered in full

Learn more with these resources:

1 This information is not a complete description of benefits. Call 1-800-671-6081 (TDD/TTY 1-800-421-1220) for more information.

Network Coverage Information - With our Medicare Advantage Preferred Provider Organization (PPO) plans you have access to both In- and Out-of-Network providers and you may see any Medicare participating provider. However, your out-of-pocket costs may be higher when you use an Out-of-Network provider, except in limited cases such as emergencies and urgently needed care. For information on how to request reimbursement for Out-of-Network claims, and information on Out-of-Network Coverage or Coverage Determinations and Appeals call Customer Care at 1-877-883-9577 , Monday - Friday, 8 a.m. to 8 p.m.; From October 1 through March 31, 8 a.m. to 8 p.m., 7 days a week (TTY/TDD 1-800-421-1220). Or, see the Evidence of Coverage using the link above. The provider network may change at any time. You will receive notice when necessary.

Out-of-network/non-contracted providers are under no obligation to treat Excellus BlueCross BlueShield members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

To the extent of any discrepancy between this web site and the Evidence of Coverage, the Evidence of Coverage terms take priority.

 

Excellus BlueCross BlueShield contracts with the Federal Government and is an HMO plan and PPO plan with a Medicare contract. Enrollment in Excellus BlueCross BlueShield depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. .
This page last updated .