Medex® Choice

The Medex Choice benefit design requires a primary care provider (PCP) selection from the HMO Blue® network. Members who select a Choice PCP (a sub-set of the HMO Blue network), will receive enhanced benefits, such as: coverage for 100% of the Medicare Part A and Part B deductibles and the coinsurance for days 21-100 for Medicare–covered admissions in a skilled nursing facility.

If a member does not select a Choice PCP and selects another HMO Blue PCP, they will not receive coverage for the Medicare Part A and Part B deductibles or coinsurance for skilled nursing facilities. The member will continue to receive coverage for the 20% Medicare Part B coinsurance after Original Medicare processes and pays the claim.

When a member needs specialty care, the member must get a referral to an HMO Blue specialist from the PCP before seeing the specialist, otherwise the Medex Choice plan may not provide coverage for the specialist care.

This plan includes the following key features, plus more.*

  • Care is coordinated by a primary care provider (PCP)
  • Choice of any PCP or other providers in the HMO Blue network
  • Benefits received outside of the HMO Blue network are not covered under Medex Choice but are covered by Original Medicare, except for emergencies and urgent care
  • It can be combined with a Blue MedicareRx (PDP) prescription drug plan, or a Dental Blue 65 plan

For more information, download our Medex brochure.

Visit the Enroll section for information on how to enroll via phone, mail or fax. Online enrollment in Medex Choice is currently unavailable.

$136.691

per month

Enroll Now

Medex®' Choice covers your co -insurance for doctor visits, home visits, and ambulatory care. When you choose a Choice PCP, Medex Choice will cover both the Medicare Part A and Part B deductibles and the skilled nursing facility co-insurance for Medicare-approved stays days 21-100.

Please use our Find a Doctor search to find a Choice PCP.

For detailed Medex Choice benefit information, please refer to the Medex Choice Solution to Supplement Medicare brochure or Outline of Medicare Supplement Coverage.

Referrals You Can Trust.
Your primary care provider will often refer you to health care providers within their own groups and hospitals whom they know and trust. This helps the doctors who care for you communicate better and give you more coordinated health care. Although a friend or relative may recommend a particular doctor, your primary care provider's expert recommendation is based on what's best for your specific medical condition. For more information on referrals, download the Referral Overview.

If you don't have a referral from your PCP before you get care from an HMO Blue specialist, your Medex Choice plan may not provide coverage for your care. In this situation, you still have the right to receive your Medicare benefits. But, you may have to pay the costs that aren't covered by Medicare (such as your Medicare deductibles and co-insurance).

Benefits at a Glance

Medex Choice

Monthly Plan Premium

$136.691

Plan Information

Original Medicare

Medex Choice (with Choice PCP)

Medex Choice (with Other PCP)

Hospital Services

1-60 Days

Coverage for 60 days, after the $1,316 deductible2

Full coverage of Medicare deductible and co-insurance

Coverage for Medicare daily co-insurance after you pay $1,316 deductible

61-90 Days

Coverage for 61-90 days, after $329 daily co-insurance

Full coverage of Medicare deductible and co-insurance

Coverage for Medicare daily co-insurance after you pay $1,316 deductible

Lifetime Reserve

Coverage for an additional 60 lifetime reserve days, after $658 daily co-insurance

Full coverage for lifetime reserve co-insurance, then an additional 365 days per lifetime when Medicare benefits end

Full coverage for lifetime reserve co-insurance, then an additional 365 days per lifetime when Medicare benefits end

Skilled Nursing Facility

1-20 Days

Full coverage for 20 days in a Medicare-participating facility

Covered by Medicare

Covered by Medicare

21-100 Days

Coverage for days 21-100, after $164.50 daily co-insurance

Full coverage for Medicare daily co-insurance for days 21-100

No Coverage

101+ Days

No coverage after 100 days

$10 a day for days 101-3653

No Coverage

Doctor and Other Provider Services

Care in the Hospital

80% coverage of approved services, after the $183 annual Part B deductible

Full coverage of Medicare deductible and co-insurance

Coverage of 20% co-insurance, after $183 annual Part B deductible

Outpatient Department Visits, Office Visits, and Patient Home Visits

80% coverage of approved services, after the $183 annual Part B deductible

Full coverage of Medicare deductible and co-insurance

Coverage of 20% co-insurance, after $183 annual Part B deductible

Other Part B Services

Ambulance Trips, Durable Medical Equipment, etc.

80% coverage of approved services, after the $183 annual Part B deductible

Full coverage of Medicare deductible and co-insurance

Coverage of 20% co-insurance, after $183 annual Part B deductible

Foreign Travel Coverage

Travel Outside the U.S.

No Coverage

Wellness Benefits

No Coverage

Medex members may receive up to $150 per calendar year in qualified health club membership fees and exercise classes

Medex members may receive up to $150 per calendar year in qualified health club membership fees and exercise classes

No Coverage

Medex members may receive up to $150 per calendar year when enrolled in a qualified Weight Watchers®” program or hospital-based weight-loss program

Medex members may receive up to $150 per calendar year when enrolled in a qualified Weight Watchers®” program or hospital-based weight-loss program

Notes:
Although the $183 calendar-year Medicare medical insurance (Part B) deductible appears more than once in this benefit chart, only one $183 deductible is applicable in a calendar year.

The Medex policy defines the terms and conditions of all the Medex plans in greater detail. Should any questions arise concerning benefits, the Medex policy will govern.

Is my doctor in the network?

If you already have a primary care provider and want to learn whether he or she is already a Choice PCP, just visit Find a Doctor or call 1-800-258-2226 (TTY: 711), 8:00 a.m. to 6:00 p.m. ET.

Looking for a new physician?

To choose a Choice PCP from our list of participating HMO Blue Network providers, follow the instructions below. Our network of physicians is subject to change, but you can keep up-to-date with the most complete list of current network doctors by:

  • Use our Find a Doctor feature or

  • Call Member Service at 1-800-258-2226 (TTY: 711) to request a copy of the directory

Referrals You Can Trust.

Your primary care provider will often refer you to health care providers within their own groups and hospitals whom they know and trust. This helps the doctors who care for you communicate better and give you more coordinated health care. Although a friend or relative may recommend a particular doctor, your primary care provider's expert recommendation is based on what's best for your specific medical condition. For more information on referrals, download the Referral Overview.

If you don't have a referral from your PCP before you get care from an HMO Blue specialist, your Medex Choice plan may not provide coverage for your care. In this situation, you still have the right to receive your Medicare benefits. But, you may have to pay the costs that aren't covered by Medicare (such as your Medicare deductibles and co-insurance).

Get Healthy Discounts & Programs

With Medex Choice, you get access to information, support, tools, and discounts to help you be your healthiest.

Program/Discount

What It Offers

Get up to $150 per calendar year toward a qualified health club or participating Council on Aging sites.

Get up to $150 per calendar year when you join a qualified Weight Watchers®'' or a hospital-based weight loss program.

Download the current issue of our quarterly newsletter for helpful health and wellness information.

  • You live in Massachusetts, and

  • You are entitled to Medicare Part A and enrolled in Medicare Part B, or

  • You are under age 65 and you qualify for Medicare coverage because of a disability, except for end-stage renal disease (ESRD)

Compliment your Medex Choice plan with additional coverage options.

Coverage Option

Preventive:
$24.40 per month

Basic:
$37.60 per month

Premier:
$59.10 per month

Blue MedicareRx Value Plus:
$43.10 per month

Blue MedicareRx Premier:
$127.70 per month

International Travel Coverage

Rates starting at $120 per year

1

You must continue to pay your Medicare Part B premium.

2

A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 consecutive days.

3

Choice coverage also includes $8 a day for days 1-365 at a non-Medicare-participating facility

*

Medex®' Choice is a Medicare supplement plan from Blue Cross Blue Shield of Massachusetts HMO Blue, a wholly controlled subsidiary of Blue Cross and Blue Shield of Massachusetts.

Primary care providers (PCPs) are part of the Blue Cross Blue Shield of Massachusetts HMO Blue® provider network. When you need specialized care, your PCP will work with you to identify the best doctor for your care and provide a referral, most often to doctors and hospitals with whom they are affiliated in the HMO Blue® provider Network.