Blue Cross details Midland County Medicare Advantage plan; eligible retirees auto-enrolled Jan. 1, 2025

Michael Chavis of Blue Cross Blue Shield of Michigan laid out the key features of Midland County—s new group Medicare Advantage plan and what retirees must do to preserve or change coverage.

Chavis said the plan is a "passive" Medicare Advantage product with no separate in-network/out-of-network benefit and that most providers who accept Medicare should accept the group plan. "Medicare Advantage... gives you all the same rights benefits and protection that you receive in original Medicare plus some," Chavis said during the presentation.

Why it matters: Midland County retirees and spouses will see changes to how medical and prescription claims are administered, and the county will automatically enroll eligible members in the new Blue Cross Medicare Advantage plan on the schedule described below unless members submit an opt-out form.

What the plan covers and costs - Enrollment and timing: Attendees were told each Medicare-eligible person should have received a pre-enrollment kit that includes a "benefits at-a-glance" and an opt-out form. Members who do not return the opt-out form will be enrolled automatically; Chavis said ID cards and welcome materials will be mailed before the plan—s effective date. The current county plan ends Dec. 31, 2024; the new plan begins Jan. 1, 2025.

- Medical cost sharing: The plan lists a $500 deductible and a $1,500 medical out-of-pocket maximum. Office visit copays are $30 for primary care and specialists, chiropractor visits $20, urgent care $35, emergency room $100 (waived if admitted within three days), and medically necessary ambulance rides $75.

- Prescription drugs: The plan uses Blue Cross—s enhanced formulary. Chavis said the formulary network covers about 64,000 pharmacies with roughly 23,000 designated preferred retail pharmacies. Prescription drug cost-sharing is tiered; Chavis noted a 2025 individual prescription out-of-pocket maximum of $2,000, after which covered drugs are paid at 100% for the remainder of the calendar year. Preferred and standard pharmacy designations affect copays; 90-day supplies are available for tiers 1—4 (including a "pay for two months, get three" structure) but are not available for specialty (tier 5) drugs.

- Prior authorization and transition fills: Prior authorizations are typically secured by the prescribing doctor; if a required authorization is denied there is an appeal process. Chavis recommended members obtain 90-day supplies where appropriate or use transition-fill provisions (short-term refills for ongoing prescriptions) to avoid disruptions when the plan takes effect.

- Wellness benefits: The plan includes SilverSneakers and other wellness and care-coordination programs; Chavis said Midland has five participating fitness centers for SilverSneakers access.

Enrollment questions and individual cases During Q&A, attendees asked about the plan—s fiscal effect and individual enrollment issues. One participant, Deanna, said her wife, Midland County retiree Ellen Gant, was "opted out" of Medicare Part B by the Social Security office in error; Deanna said the office "admitted that they made a mistake and opt her out of Part B." Chavis confirmed Blue Cross and the county were aware of the case and said the county can place the retiree in a temporary safe status so she retains current benefits through January and transitions to Medicare Advantage on Feb. 1 once Part B is effective and a copy of the Part B card is provided.

Chavis also said the county—s move to the Medicare Advantage group plan helps reduce the county—s post-employment benefit (OPB) liability, but noted county staff (Bridget) who could answer specific employer-contribution questions was not present at the session.

How to get help and next steps Chavis advised members to check that they received pre-enrollment packets, to return opt-out forms if they decline coverage, and to provide copies of any new Medicare Part B cards to county staff as soon as they are issued. Members were told they can review explanations of benefits online or wait for mailed EOBs, use the Blue Cross mobile app to check prior authorizations, and call member services (Blue Cross phone number provided during the session) for additional help. Meeting registrants will receive the PowerPoint and a recording of the presentation.

Representative quotes "You will automatically be enrolled," Chavis told attendees when describing the county—s default enrollment process for Medicare-eligible retirees; he reiterated members will receive ID cards and post-enrollment Evidence of Coverage materials.

Deanna, a meeting participant whose wife is a Midland County retiree, described the Social Security error: "They admitted that they made a mistake and opt her out of Part B," and the presenters described steps to avoid a coverage gap.

What to monitor: Watch for county emails with the pre-enrollment kit and opt-out form, confirm receipt of any new Medicare Part B cards with county staff, and check the Blue Cross mobile app or member services for explanations of benefits and prior authorization status.

The county presentation closed with contact information for member services and a reminder that registrants will receive the slide deck and meeting recording.