1. Who is eligible to enroll for Blue Medicare PPO?
2. How is Blue Medicare PPO different from Medicare Supplement health insurance coverage?
3. How can Blue Medicare PPO be offered at such an economically priced plan premium?
4. What would my payment responsibility be if it becomes necessary for me to use an out-of-network specialist provider due to a network inadequacy?
5. How do I apply for extra help?

Who is eligible to enroll for Blue Medicare PPO?

Blue Medicare PPO is open to all Medicare beneficiaries eligible by age or disability in the Plan's service area. You must be entitled to Medicare under Part A and enrolled in Medicare Part B and live in New Mexico. You must continue to pay your Medicare Part B premium and Part A premium, if applicable. Blue Medicare PPO is available to Medicare beneficiaries and is an approved Medicare advantage plan. (Individuals with end-stage renal disease are not eligible to enroll.) If you had a kidney transplant and no longer need dialysis, or if you enrolled in a Medicare Advantage Plan that has withdrawn from your coverage area, then you may enroll in Blue Medicare PPO.

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How is Blue Medicare PPO different from Medicare Supplement health insurance coverage?

Blue Medicare PPO is a Medicare Advantage health insurance plan. Congress created the Medicare Advantage program to offer Medicare beneficiaries more choices, and in many cases, more benefits than those offered through Original Medicare. Medicare Supplement health insurance plans are designed to supplement the benefits of Original Medicare only, and are not part of the Medicare Advantage program. With the Blue Medicare PPO plan, you do not need to be covered by a Medicare Supplement health insurance plan.

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How can Blue Medicare PPO be offered at such an economically priced plan premium?

This health insurance plan is made possible by a contract between HCSC Insurance Services Company (Blue Medicare PPO) and Centers for Medicare & Medicaid Services (CMS). As an approved "Medicare Advantage Plan", Blue Medicare PPO can offer an economical plan premium by providing your care through a network of doctors, specialists, and hospitals while still giving you the freedom to receive care out of the network, if you choose.

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What would my payment responsibility be if it becomes necessary for me to use an out-of-network specialist provider due to a network inadequacy?

You will only be responsible for the specialist copayment amount if you or your provider take the required action to pre-authorize the expected service.

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How do I apply for extra help?

You can apply for extra help in one of three ways:

• Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week. For the hearing or speech impaired, please call 1-877-486-2048.
• Contact your State Medicaid Office.
• Call the Social Security Administration at 1-800-772-1213, Monday - Friday, 7 a.m. - 7 p.m. CST. For the hearing or speech impaired, please call 1-800-325-0778.

Medicare beneficiaries whose income falls within certain guidelines set forth by CMS, the federal agency that administers the Medicare prescription drug program, may qualify for extra help. Eligibility is determined by the beneficiaries' annual income and assets. (Assets include savings and stock holdings, but not homes or cars.)

Low Income Subsidy Premium

Your level of extra help	Monthly premium for the Blue Medicare PPO Value Plan	Monthly premium for the Blue Medicare PPO  Advantage Plan	Monthly premium for the Blue Medicare PPO  Premier Plan
100%	$0.00	$0.00	$19.70
75%	$0.00	$3.70	$24.20
50%	$0.00	$7.40	$28.60
25%	$0.00	$11.20	$33.10

The premiums listed do not include the amount you pay for your Medicare Part B premium.

For more information about Low-Income Subsidy, visit the Centers for Medicare & Medicaid Services (CMS).

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