Medicare Supplement FAQ
These questions and answers summarize some of the plan’s highlights. For a complete description of your benefits, please refer to the appropriate Plan Summary document in Resources. If there are any differences between this information and the plan documents, the plan documents will govern.
A Medicare Supplement plan pays benefits for services after Medicare pays their portion.
Stanford offers 1 Medicare Supplement plan:
Blue Shield Retiree Plan, available worldwide
Medicare Supplement plans work like a PPO; you can seek services from any licensed provider. However, if your doctor is in your medical plan’s network and accepts payment from Medicare, your costs will be lower.
Yes. You must be enrolled in both Medicare Part A and B to enroll in any of the options. You are also responsible for making your monthly Medicare payments as well as any Stanford health plan payments in order to maintain your health coverage.
To get information about signing up for Medicare Part A and B, contact the Social Security Administration at http://www.ssa.gov or (800) 772-1213 approximately three months before age 65 or within three months before you retire.
Part D is Medicare’s prescription drug program. You do not need to sign-up for Part D because all Stanford medical plans provide prescription drug coverage as part of the plan that overall are equal to or better than Part D.
You do not need to fill out any forms unless you and/or your dependents are changing to a Medicare Supplement plan from a Medicare Advantage plan. If this is the case, then each family member must complete a Medicare Advantage Disenrollment Form. Call the University HR Service Team at (877) 905-2985 to get a Disenrollment Form(s). If you do not complete the Disenrollment Form on time, your Medicare stays assigned to the Medicare Advantage Plan until the following month.
A primary care physician (PCP) is a doctor you choose to manage all your health care. Your PCP provides preventive and routine care and refers you to specialists and hospitals, as needed. A PCP can be an internist, a family or general practitioner, or a pediatrician for your child. You choose your PCP from the network of doctors in your health plan.
You are not required to choose a PCP if you choose the Blue Shield Retiree Plan.
If you are enrolled in the Blue Shield Retiree Plan, you may refer yourself to a specialist. However, your costs will be lower if you choose a specialist in your plan’s network of providers.
You may be responsible for submitting claims to your plan if you do not have Medicare Crossover Billing. You must establish Medicare Crossover Billing with your medical plan. Keep reading for more information.
When you set up Medicare Crossover Billing, your medical provider automatically sends claims to Medicare. After Medicare processes the claim, notification is sent to your medical plan so your plan can pay their share of the charges. This free, convenient service reduces your claims paperwork.
If you do not set up Crossover Billing, you must wait until Medicare pays its benefits and you receive your Explanation of Medicare Benefits. Then, you have to submit a copy of it along with a claim form to your medical plan. This process creates more work for you and may result in a delay receiving full reimbursement.
To set up Medicare Crossover Billing you must call your medical plan’s member services number on your medical ID card. They will ask for your 11-digit alphanumeric Member Beneficiary Identifier (MBI) located on your Medicare card and the effective date of your Medicare Part A and Part B coverage.
You cannot search using the names of the contracted parent organizations SHC and Sutter. You have to drill down to the specific medical group names. Go to Blue Shield's microsite and use their "Find a doctor" provider search tool:
https://myoptions.blueshieldca.com/stanford/stanford/index#fad
Use Stanford Medical Group for SHC and Palo Alto Medical Foundation for Sutter to find these commonly used medical groups in the Bay Area.
You can call your doctor’s office and ask if they are part of the plan’s network, or view the medical plan’s provider directory on their Web site. See Contacts.
For the Blue Shield Retiree Medical Plan (Group # PPOX0005) Here are some tips when making a provider selection:
To receive the maximum benefits, your provider(s) must accept Medicare Assignment – they do not have to be contracted with Blue Shield. If they accept Medicare’s assignment, Medicare will pay 80% for covered services and your Stanford - Blue Shield Retiree Medical plan will pay your deductible and the 20% Medicare co-insurance. Leaving you with $0.00 member responsibility.
If your provider does not accept Medicare Assignment and is a Blue Shield contracted provider, the plan offers a second level of coverage. For covered services, there is an annual $100 deductible and 20% coinsurance which would be the member's responsibility.
You may be responsible for additional costs not covered by your medical plan. Since a non-network provider has not agreed to any discounts with your medical plan you pay any charges not covered by your plan. Your non-network provider will normally bill you for these charges (also called “balance billing”).
When you see a network provider, there is no balance billing and your out-of-pocket costs are generally lower and more predictable.
No. There are no pre-existing condition limits in any of Stanford University’s medical plans.
Your prescription drugs are covered by your medical plan. The cost of your medication depends on whether or not it can be dispensed in a generic form or if it is included in the medical plan’s formulary.
A formulary is a list of approved prescription drugs covered by the plan. The formulary for Blue Shield has three tiers: generic, brand name, and non-formulary. This means your medication will generally be available to you, although the copayment depends on what tier it falls into – generic being the least expensive and non-formulary the most expensive.
To find out if a particular medication is on your plan’s formulary, go to your plan’s Web site or call their member services number on your medical ID card.
Compare medical plans for more information on your out-pocket costs. You can also review your plan’s Plan Summary, located in Resources.
Yes. The plans cover emergency care for injury or illness worldwide as long as you (or a family member, friend or representative) contacts the plan within 48 hours of receiving emergency care.
Yes. The plans cover routine physicals every year for adults and children, plus annual well-woman exams. Look at the comparison chart to compare medical plans. You can also refer to the Plan Summaries, located in Resources, or contact for the plan directly to ask your questions.
Stanford plans cover routine eye exams and medically necessary treatment of your eyes, such as surgery. Your plan also has limited hearing benefits including hearing aids. For specific information, call your plan’s member services number listed on your medical ID card.
Each plan covers the Medicare deductibles and coinsurance for Medicare-approved services. However, you may be responsible for a copayment after Medicare and your medical plan pay their share. We recommend you wait until you receive your plan’s Explanation of Benefits (EOB) that will show your share of the cost.
Refer to your plan’s Plan Summary and the Medical Plan Comparison Chart as a guide to what may be covered. Do not assume this is a guarantee that any particular medical treatment or service would be covered. Medical coverage is based on medical necessity as it applies to the diagnosis given. You can also call your plan’s member services number listed on your medical ID card.
In the Blue Shield Retiree plan, you and your enrolled dependents have limited coverage worldwide wherein certain elective services are excluded.