I was eligible for Medicare last summer, so signed up in the appropriate window of time....I was then offered Michigan BlueCross/Blue Shield PPO network plan, so took that also as supplemental.
As it currently stands right at the moment, my Medicare health insurance entitles me to 'Hospital (Part A)' and 'Medical (Part B)' - as mentioned, my supplemental is Blue Cross / Blue Shield of Michigan....on upper right corner of card, it also reads Medicare Plus Blue PPO...
Your BCBS plan is not a supplement. It's a Medicare Advantage plan. You don't have Medicare; you're on a Medicare Advantage plan.
From what you said, this appears to be your plan:
https://www.bcbsm.com/medicare/plans/ma/2023-ppo-essential/
"Traditional" Medicare is Part A (which for most people is free) and Part B, which everyone must pay a premium for (that's what your quarterly $510 and now $494 payments are). Medicare itself pays 80% of approved charges, and the Medicare beneficiary is responsible for the other 20%. To cover that 20%, some (most) people buy a supplement, and they pay the premium for the supplement directly to the supplement company.
The supplement simply pays your 20% on your behalf, and has no say in whether procedures are covered by Medicare and has no say in whether it will pay a claim. If Medicare approves a claim and therefore pays its 80%, the supplement has no choice but to pay your 20% on your behalf.
If the word "network" or "HMO" or "PPO" is ever mentioned with respect to any sort of Medicare plan, it is NOT a supplement, but instead a Medicare Advantage plan.
People who choose Medicare Advantage also have to pay the Part B premium, so any time an Advantage plan is advertised as "free," it means only that there is no cost
in addition to the Part B premium that every Medicare beneficiary pays. Advantage plans have their own premiums. Depending on the plan provisions, an Advantage plan can have a premium that you pay in addition to the Part B premium, it might have a $0 premium (so you have to pay only the Part B premium), or it might have a "negative" premium, which is the "money back on your social security check" they tout (the amount that is deducted for the Part B premium is reduced).
With traditional Medicare, the government pays 80% of your doctor bills, and either you or your supplement pays the other 20%. With Medicare Advantage, the government pays the Advantage company a set amount per enrollee (which can vary based on a person's health status), and turns all of the enrollee's healthcare over to the Advantage company--whether procedures are covered, how much they'll pay providers, how much you'll have to pay, etc. Medicare has nothing to do with you any more at that point--it's all your Medicare Advantage company.
Advantage plans vary. Some are like an HMO, with a local network that you have to stay in, referrals required for visits to specialists, and they have to approve in advance any procedures you get. But some, like the one you have, DO cover providers outside the network and don't require referrals to see specialists, and still offer the "add-ons" that Advantage plans are know for, like hearing aid coverage and gym memberships and the like.
So Advantage plans can be a real money saver, but they should be chosen for a reason, knowing the advantages and disadvantages, and I think that rarely happens.
I can't really get a bead on how the more expansive Medicare Advantage plans work, since HMOs make money by managing care, and if an Advantage plan isn't managing care, how can it make money? That's one reason I chose traditional Medicare--at least I understand how it works. But there
are Advantage plans that cover you if you see out-of-network providers (yours does), and there are some that say they will provide coverage if you see any doctor who accepts Medicare.
We're fixing to start a Medicare Advantage Open Enrollment Period, which is different from the Medicare Open Enrollment period that just ended. From January through March, people with Advantage plans can change to another Advantage plan one time. They can also "revert" to traditional Medicare (although I've never seen a definition of "revert"--does it mean the person had to have traditional Medicare at some point in the past, or is it just a sloppy use of the word "revert"?).
But be aware--if you "revert" to traditional Medicare, it's a good idea to have a supplement to limit your exposure under the 20% Medicare doesn't pay (there's no out-of-pocket maximum for that 20%). However, since you have passed your Medicare initial enrollment period, because you live in Michigan, you will never have guaranteed-issue rights to any supplement. You will have to apply and be accepted, based on your health status.
Only a handful of states provide for guaranteed-issue periods for supplement. In every other state, medical underwriting for supplements is allowed. Because of that, some people who are on an Advantage plan find they can never switch to traditional Medicare if their health deteriorates to the point they can't pass medical underwriting for a supplement, and they don't want to have traditional Medicare without the protection of a supplement.
