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Blue Medicare Advantage^SM

Blue Medicare Advantage HMO, a plan that offers all of the coverage of Original Medicare — plus benefits not covered by Medicare or most Medicare Supplement insurance plans, including built-in prescription drug coverage. Think of it is as an all-in-one plan.

Whether you’re new to Medicare or thinking about switching plans, here are some important things to consider before choosing Blue Medicare Advantage.

• Be sure you are eligible for Medicare. Your primary residence must be in Cook, DuPage, Kane or Will counties to enroll in Blue Medicare Advantage.
• If you're eligible for Medicare and planning to retire, speak with your benefits administrator at work about your benefit options.
• Learn how Medicare Advantage works.
• Review the 2013 Blue Medicare Advantage plan benefits and built-in drug coverage below.
• If you’d like to enroll in a Medicare Advantage plan, make sure you're aware of enrollment periods. Members may enroll in the plan only during specific times of the year.
  
  

2013 Blue Medicare Advantage plan benefits:
Benefit	In-Network
Monthly premium	$0.00
Maximum medical out-of-pocket cost	$3,400.00
Doctor office visits	$7 copay for each Medicare-covered primary care doctor visit $45 copay for each Medicare-covered specialist visit
Inpatient hospital care	Days 1-7: $240 copay per day Days 8-100: $0 copay per day
Emergency care	$65.00
2013 Blue Medicare Advantage built-in drug coverage:
Prescription deductible	$325 for tiers 3, 4 & 5 only
Copay Tier 1 Preferred Generic Drugs	$3.00
Copay Tier 2 Non-preferred Generic Drugs	$11.00
Copay Tier 3 Preferred Brand Drugs	$45.00
Copay Tier 4 Non-preferred Brand Drugs	$95.00
Coinsurance Tier 5 Specialty Drugs	25%
Copay gap coverage	After your total yearly drug costs reach $2,970, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan’s costs for brand drugs and 79% of the plan’s costs for generic drugs until your yearly out-of-pocket drug costs reach $4,750.

Evidence of Coverage
H3822_BEN_IL_MAPDEOC2013 Accepted 09052012

Evidence of Coverage en Espanol
H3822_BEN_IL_MAPDEOC2013aSPA Accepted 09052012

Summary of Benefits
H3822_IL_BEN_BNFTSMRY13 Accepted 09152012

Summary of Benefits en Espanol
H3822_IL_BEN_BNFTSMRY13SPA Accepted 09152012

You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply. Find more information here . If you would like to submit feedback directly to Medicare, please use the Medicare Complaint Form  or contact the Office of the Medicare Ombudsman .