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Would you like a Medicare plan with lower cost sharing and additional benefits, including a 24-hour nurse advisor? With Medicare BlueSM Private (PFFS), a private fee-for-service plan, you can enjoy all the benefits of the original Medicare plan. Medicare Blue Private (PFFS) does not pay after Medicare pays its share, but rather, it pays instead of Medicare and the beneficiary pays any applicable cost share or copayment. Medicare Blue Private (PFFS) is open to all South Carolina residents who have Medicare Part A and Part B.
The monthly premium is $0 statewide. If you currently pay a premium for Medicare Part A and/or Medicare Part B, you must continue paying your premium in order to keep Medicare Part A and/or Medicare Part B and remain a member of this plan.
You can use any Medicare doctor, specialist or hospital that accepts Medicare payment and accepts the terms, conditions and payment rate of the Medicare Blue Private (PFFS) plan. BlueCross has the right to determine if Medicare Blue Private (PFFS) covers the service or treatment your health care provider orders. Vision care benefits are only available through opthalmologists, optometrists and opticians listed in our Vision Directory. To access the most recent list of vision care providers, visit the Provider Locator. On behalf of BlueCross, EyeMed provides a vision care provider network. EyeMed is an independent company.
Verify that your provider will accept the Medicare Blue Private (PFFS) plan. Your health care providers have the right to choose whether to accept a private-fee-for-service plan's payment terms and conditions every time you see your providers.
If your provider decides not to accept the plan, you will need to find another provider that will. They should not provide services to you, except in an emergency.
If they choose to provide services, they may not bill you. They must bill the private-fee-for-service plan for your covered health care services. You must pay the appropriate copayments and coinsurance.
You can switch plans during the open enrollment period every year from November 15 to December 31. Medicare may also allow you to change plans under special circumstances, such as if you permanently move out of your plan’s service area; if you get help from your state Medicaid program paying Medicare premiums and/or cost sharing; if you qualify for extra help paying for prescription drugs; or if you enter, live in, or leave a nursing home.
The Medicare program rates how well health plans perform in different categories (for example, ratings in customer service and detecting and preventing illnesses). On www.medicare.gov you can compare the ratings for Medicare in plans in your area by selecting “Compare Medicare Prescription Drug Plans” or “Compare Health Plans and Medigap Policies in Your Area.” You can also get a copy of the ratings by calling us at 1-888-645-6025 (TTY 1-888-645-6023) - 8 a.m. to 8 p.m., seven days a week. A Medicare Advantage private-fee-for-service plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to accept the plan's terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to you, except in emergencies. Providers can find the plans' terms and conditions on our Web site at www.SouthCarolinaBlues.com/pffs10/TNC. Original Medicare will not pay for your health care while you are enrolled in a private-fee-for-service plan. The benefit information provided here is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement. For more information, contact the plan. Medicare Blue Private (PFFS) is a Medicare private-fee-for-service plan and has a contract with the federal government.
Last updated: 1/28/10 M0054_WPFFS10 (02/2010)
