MyBlue Medigap℠ benefits

Medigap basics

Blue Care Network of Michigan (BCN) offers MyBlue Medigap options for Plans A, C or F only. Other Michigan insurance carriers may offer other or additional plans, but Medigap plans can be sold in only 12 standard plans plus two high deductible plans (Plans A through J, and K and L). Every insurer must make Plan A available. Plan A covers basic benefits:

BASIC BENEFITS: For Plans A – J

Plan A B C D E F/F* G H I J/J*
Basic Benefits x x x x x x x x x x
Skilled Nursing
Coinsurance 		    x x x x x x x x
Part A Deductible   x x x x x x x x x
Part B Deductible     x     x       x
Part B Excess           100% 80%   100% 80%
Foreign Travel
Emergency 		    x x x x x x x x
At-Home Recovery       x     x   x x
Preventive Care not
covered by Medicare 		                   

Blue Care Network offers Medigap options for Plans A, C and F. The overview of other plans is included for your information.

Basic Benefits for Plans K and L include similar services as plans A-J, but cost-sharing for the basic benefits is at different levels.

BASIC BENEFITS: For Plans K – L

Plan K** L**
Basic Benefits 100% of Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end

50% Hospice cost-sharing

50% of Medicare-eligible expenses for the first three pints of blood

50% Part B coinsurance, except 100% coinsurance for Part B preventive services		 100% of Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end

75% Hospice cost-sharing

75% of Medicare-eligible expenses for the first three pints of blood

75% Part B coinsurance, except 100% coinsurance for Part B preventive services
Skilled Nursing
Coinsurance 		50% skilled nursing facility coinsurance 75% skilled nursing facility coinsurance
Part A Deductible 50% Part A deductible 75% Part A deductible
Part B Deductible    
Part B Excess    
Foreign Travel
Emergency 		   
At-Home Recovery    
Preventive Care not
covered by Medicare 		   
$4,000 out of pocket Annual Limit*** $2,000 out of pocket Annual Limit***

* Plans F and J also have an option called a high deductible plan F and a high deductible plan J. These high deductible plans pay the same benefits as Plans F and J after one has paid a calendar year ($1,790) deductible. Benefits from high deductible Plans F and J will not begin until out-of-pocket expenses exceed $1,790. 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.

** Plans K and L provide for different cost-sharing for items and services than Plans A-J. 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.

Choose a MyBlue Medigap plan option that meets your needs

Please download the MyBlue Medigap plan brochure for a detailed outline of coverage.

Download the MyBlue Medigap plan brochure to compare benefits and premiums among policies, certificates of coverage and contracts and premiums offered by BCN 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. 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 Guide to Health Insurance for People with Medicare.

Note: The MyBlue 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 MyBlue Medigap plan you select.

Once enrolled in MyBlue Medigap, we’ll send you a member ID card and plan handbook that provides comprehensive details about your coverage. The certificate of coverage is your contract with BCN. The following is only an outline describing the most important features of BCN’s certificate of coverage. You must read the certificate to understand all of the rights and duties of both you and BCN. For more information about MyBlue Medigap coverage, call 1-877-469-2583, or contact your Blue Care Network agent. TTY users should call 1-800-481-8704.

Like Medicare, MyBlue 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 MyBlue 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.



MyBlue Medigap offers access to any hospital, doctor or other health care provider in the U.S. or its territories that accepts Medicare assignment. The plan does not require members to use a specified provider network. MyBlue Medigap is a Medigap plan administered by Blue Care Network. Certain factors may affect the monthly premium cost: geographic location of the applicant’s residence, age, gender, height, weight and whether the applicant uses tobacco. Neither Blue Care Network nor its agents are connected with Medicare.

page modified 11/13/2009