Senior Gold Benefits

Senior Gold^SM 2010 Benefits

Benefit category		Original Medicare	Senior Gold with preventive care coverage
Monthly premium Application Blue Cross Minnesota Medicare BCBSSeniorGold Brochure Blue Cross Medicare Plans Part D Options		You pay the Medicare Part B premium of $96.40 – $308.30 each month.	In addition to the Medicare Part B premium, you pay • Tobacco-free: $199 Standard rate: $261 Includes optional preventive care coverage: $5
Deductible		You pay Part A deductible of $1,068 and Part B deductible of $135.	You pay $0. Senior Gold covers your Part A and Part B deductibles.
Preventive services	Routine physical exams	You pay 20% of Medicare-approved amounts for one physical exam within the first 6 months of your new Part B coverage, not including laboratory tests. You pay 100% for any additional routine physical exams.	You pay $0 for one physical exam per year. (This benefit is only available if enrolled in optional preventive care coverage.)
Preventive services	Cancer screenings, includes colorectal and prostate screenings, and mammograms	You pay 20% of Medicare-approved amounts, except for approved lab services in which case you pay $0.	You pay $0 and the plan offers broader coverage of cancer screenings than Original Medicare.
Doctor office visits, specialist visits and urgently needed care		You pay 20% of Medicare-approved amounts or applicable copayment.	You pay $0.
Emergency care		You pay 20% of the facility charge or applicable copayment for each emergency room visit (unless admitted to the hospital within 3 days for the same condition). You pay 20% of doctor charges.	You pay $0 for each Medicare-covered emergency room visit.
Inpatient care		You pay for each benefit period: • Days 1 – 60: $1,024 deductible • Days 61 – 90: $256 per day • Days 91 – 150: $512 each lifetime reserve day	You pay $0 for each Medicare-covered stay. You are covered for unlimited days each benefit period.
Outpatient care, services and surgeries		You pay 20% of Medicare-approved amounts for doctor charges. You pay 20% of outpatient facility charges.	You pay $0.
Diagnostic tests, X-rays and lab services		You pay 20% of Medicare-approved amounts, except for approved lab services in which case you pay $0.	You pay $0 for Medicare-eligible services.
Other equipment and supplies	Durable medical equipment, includes wheelchairs, oxygen, etc.	You pay 20% of Medicare-approved amounts.	You pay $0 for each Medicare-covered item.
Other equipment and supplies	Diabetes supplies, includes glucose monitors, test strips and lancets	You pay 20% of Medicare-approved amounts.	You pay $0 for each Medicare-covered item.
Worldwide coverage		Generally NOT covered outside the United States.	You pay 20% for emergency care outside the United States.