2012 plan information

MyBlue Medigap℠ premiums

For MyBlue Medigap plans, certain factors may affect your monthly premium. We base your premium on the area you live in and your age, gender, height, weight, and whether you use tobacco.

Please note: If you are submitting your application within six months after you first enrolled for benefits under Medicare Part B or if you are within the guaranteed issue period, your premium will not be affected by your weight, height, tobacco use, health status, claims experience, receipt of health care or medical condition. (In the outline of coverage (PDF)), we refer to either status as your “Special Enrollment” period.) In all cases, Blue Care Network will not reject your application based on your health status or your age.

Your premium is based on your current age and will change as you age; the change will be reflected each year on the date of renewal. We can only raise your premium if we raise the premium for all policies like yours in Michigan.

Find your monthly premium

Follow these steps:

  1. Use our Body Mass Index (BMI) chart to determine your BMI value. Your BMI value is based on your height and weight and will tell you which rating tier you belong in.
  2. Click the rate table link below based on which of the following statements applies to you:
  3. Find your rate in the appropriate table linked above. Here’s how:
    • Find the plan option that’s right for you and the Tier in which you belong based on your BMI value.
      • If you live in a ZIP code that begins with 480 through 485, you are in Area 1
      • If you live in any other ZIP code in Michigan, you are in Area 2
    • Once you find the correct table, scroll down the first column to find your age. Your premium will be shown at the right, based on whether you use tobacco and whether you’re male or female.

An example of how to find your monthly MyBlue Medigap premium

The following is an example of how to calculate an estimated MyBlue Medigap premium:

Mary selected Plan F.

She’s a 66-year old woman who does not use tobacco. Her weight is proportionate to her height. As a result, her Body Mass Index is just 25, placing her in Tier 1. Mary lives in the 48037 ZIP code, placing her in Area 1. She’s been enrolled in Medicare Part A and Part B for more than a year.

She did the following to find her monthly MyBlue Medigap premium:

STEP 1 – Because Mary has had Medicare Part B for at least six months, she must look under “Monthly premium rates for individuals enrolled in Medicare Part B six months or longer.” She goes to the tables for Plan F and finds the table for Tier 1.

STEP 2 – Mary looks under the Area 1 columns (ZIP codes beginning with 480 through 485), then scrolls down the AGE column at left to find her age: 66 years.

STEP 3 – She scrolls to the right to find the “Non Tobacco User” columns, and within that, “Female.”

STEP 4 – Mary's monthly premium is $172.89.

Your payment options

Complete the Authorization Agreement for Automatic Payments form (PDF) to have premiums automatically deducted from your bank account. To pay by personal check, money order or cashier’s check, download the MyBlue Medigap Application for Coverage form (PDF) for payment details. Premium payments are due the 5th of each month.

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 agents authorized to sell Blue Care Network policies are connected with Medicare.

page modified 12/08/2011