More Benefits and Added Value
Thank you for your interest in Blue Medicare Supplement from
Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
We’re proud to be one of North Carolina’s leading health insurance companies. Today, more than 4.1 million customers¹ rely on us for their health insurance. We’re proud to have been serving North Carolina for over 90 years. We know North Carolina, and we know you. We pride ourselves on giving back to our communities, offering plans that meet the needs of our members, and providing local customer service across the state.
We hope you’ll join us for this next step in your health care journey!
1 Blue Cross and Blue Shield of North Carolina Membership Summary, May 2025.
Original Medicare covers many health care services, but it doesn’t pay for all of your costs, such as copayments, coinsurance, and deductibles. For example, for Part B covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This is called your coinsurance.¹
A Blue Medicare Supplement plan can give you additional coverage for Medicare deductibles and coinsurance for services like: Hospital stays, skilled nursing facilities, physician services, diagnostic tests, and medical and surgical services and supplies. You’ll also be covered for Medicare-eligible costs not covered by Original Medicare.
Note: Policy benefits are limited to those approved by Medicare for payment.
Enrollment is simple. You’re eligible for Blue Medicare Supplement coverage if you meet all of the following criteria:
If you enroll within 30 days following your 65th birthday, or if you have six months of continuous prior coverage, the six month waiting period for pre-existing conditions will be waived. Pre-existing conditions are conditions for which you received medical advice or treatment in the six months before the effective date of coverage. If you wait until after the deadline to enroll, you may have a waiting period for pre-existing conditions and may have to complete a medical questionnaire.
1 Source: www.medicare.gov/basics/costs/medicare-costs, (November 2025).
Notes:
4
Original Medicare is run by the federal government. The government pays hospitals and doctors directly for health care.
Part A examples: Hospital visits, skilled nursing facility care, home health services, hospice care.
Part B examples: Doctor visits, preventive services, outpatient care, screenings and lab testing, ambulance services, physical and speech therapy.
Part D is a stand-alone Medicare prescription drug plan that can be added to Medicare Parts A
and/or B. Part D plans are offered by private insurers like Blue Cross NC. Medicare requires that
all private insurers providing Medicare Part D coverage offer the Medicare standard coverage.
They may also choose to provide enhanced coverage.
Additional coverage that can help cover out-of-pocket expenses, including Part A hospital
deductible and Part B coinsurance. A plan that helps cover out-of-pocket expenses from
Original Medicare, including copayments, coinsurance, and deductibles. Medicare Supplement
plans are offered by private insurers like Blue Cross NC.
Medicare Part C (Medicare Advantage) plans are offered by private insurers like Blue Cross
NC. Medicare Advantage plans cover everything covered by Original Medicare plus additional
benefits. Most Medicare Advantage plans include Part D prescription drug coverage. Because
Original Medicare does not have an out-of-pocket maximum or cap on your costs, your out-ofpocket costs are typically lower with Medicare Advantage.
We’re here to help you choose the Blue Medicare Supplement plan with the benefits most important to you. We currently offer five Blue Medicare Supplement plans, each with benefits to meet your needs.
As you compare plans across insurers, keep in mind there are two types of Medicare Supplement plans: Attained-age and entry-age (also known as issue-age plans). Premiums for entry-age plans do not increase with age. Blue Medicare Supplement plans are attained-age plans. This means your premium will increase as you age. Your premium may also be adjusted for medical inflation or because of overall claims experience. Your premium will not increase based on your own individual health. If your premium is about to change, you will receive a 45-day notice. Your new premium is guaranteed for 12 months.
| Benefits | Plan A pays BMS A, 1/26 | Plan G pays BMS G, 1/26 | High Deductible Plan G pays BMS HDG, 1/26 | Plan K pays BMS K, 1/26 | Plan N pays BMS N, 1/26 |
|---|---|---|---|---|---|
| Part A (Hospitalization) | |||||
| $1,736 inpatient hospital deductible each benefit period | ✓ | ✓ | Covers 50% | ✓ | |
| $434 a day copayment for days 61-90 in a hospital | ✓ | ✓ | ✓ | ✓ | ✓ |
| $868 a day copayment for days 91-150 (lifetime reserve)2 | ✓ | ✓ | ✓ | ✓ | ✓ |
| 100% of Medicare-allowable expenses for additional 365 days after Medicare hospital benefits are exhausted | ✓ | ✓ | ✓ | ✓ | ✓ |
| $217 a day for days 21-100 in a skilled nursing facility3 | ✓ | ✓ | Covers 50%4 | ✓ | |
| Part B (Physician & Medical Services) | |||||
| Generally, 80% of Medicare-approved amount (Part B coinsurance) after Part B deductible is met | ✓ | ✓ | ✓ | ✓ | Up to $20 per office visit Up to $50 per ER visit |
| 100% of Medicare Part B excess charges | ✓ | ✓ | |||
| Age | Plan A | Plan G | High Deductible Plan G | Plan K | Plan N | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | |
| <65 | $1,385.25 | $1,584.00 | $1,504.75 | $1,720.75 | N/A | N/A | N/A | N/A | N/A | N/A |
| 65 | $196.50 | $224.75 | $179.50 | $205.50 | $31.50 | $36.00 | $121.25 | $138.75 | $150.75 | $172.75 |
| 66 | $203.25 | $232.50 | $184.25 | $211.00 | $31.50 | $36.00 | $125.25 | $143.50 | $154.75 | $177.25 |
| 67 | $210.00 | $240.25 | $189.00 | $216.25 | $31.50 | $36.00 | $129.25 | $148.25 | $160.50 | $183.75 |
| 68 | $216.75 | $248.25 | $193.75 | $221.75 | $31.50 | $36.00 | $133.50 | $152.75 | $164.25 | $188.00 |
| 69 | $223.75 | $256.00 | $198.25 | $227.00 | $31.50 | $36.00 | $137.50 | $157.50 | $168.25 | $192.75 |
| 70 | $228.50 | $261.50 | $212.50 | $243.00 | $32.50 | $37.25 | $143.00 | $163.75 | $179.50 | $205.50 |
| 71 | $233.75 | $267.75 | $226.50 | $259.25 | $32.50 | $37.25 | $148.50 | $170.00 | $191.50 | $219.25 |
| 72 | $239.00 | $273.50 | $240.50 | $275.25 | $32.50 | $37.25 | $153.75 | $176.25 | $204.25 | $233.75 |
| 73 | $243.75 | $279.00 | $254.50 | $291.25 | $32.50 | $37.25 | $159.25 | $182.50 | $216.25 | $247.50 |
| 74 | $249.25 | $285.25 | $268.50 | $307.25 | $32.50 | $37.25 | $164.75 | $188.50 | $228.00 | $261.00 |
| 75 | $254.00 | $290.75 | $282.75 | $323.50 | $36.00 | $41.25 | $170.00 | $194.75 | $240.00 | $274.75 |
| 76 | $259.50 | $296.75 | $296.75 | $339.50 | $36.00 | $41.25 | $175.75 | $201.00 | $252.00 | $288.50 |
| 77 | $264.50 | $302.75 | $310.75 | $355.50 | $36.00 | $41.25 | $181.00 | $207.25 | $264.00 | $302.00 |
| 78 | $269.25 | $308.25 | $324.75 | $371.75 | $36.00 | $41.25 | $186.25 | $213.25 | $276.00 | $315.75 |
| 79 | $274.50 | $314.00 | $339.00 | $387.75 | $36.00 | $41.25 | $192.00 | $219.75 | $287.75 | $329.50 |
| 80+ | $279.75 | $320.25 | $353.00 | $403.75 | $36.00 | $41.25 | $197.50 | $226.00 | $299.75 | $343.00 |
| Age | Plan A | Plan G | High Deductible Plan G | Plan K | Plan N | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | |
| <65 | $1,410.25 | $1,609.00 | $1,529.75 | $1,745.75 | N/A | N/A | N/A | N/A | N/A | N/A |
| 65 | $221.50 | $249.75 | $204.50 | $230.50 | $44.00 | $48.50 | $146.25 | $163.75 | $175.75 | $197.75 |
| 66 | $228.25 | $257.50 | $209.25 | $236.00 | $44.00 | $48.50 | $150.25 | $168.50 | $179.75 | $202.25 |
| 67 | $235.00 | $265.25 | $214.00 | $241.25 | $44.00 | $48.50 | $154.25 | $173.25 | $185.50 | $208.75 |
| 68 | $241.75 | $273.25 | $218.75 | $246.75 | $44.00 | $48.50 | $158.50 | $177.75 | $189.25 | $213.00 |
| 69 | $248.75 | $281.00 | $223.25 | $252.00 | $44.00 | $48.50 | $162.50 | $182.50 | $193.25 | $217.75 |
| 70 | $253.50 | $286.50 | $237.50 | $268.00 | $45.00 | $49.75 | $168.00 | $188.75 | $204.50 | $230.50 |
| 71 | $258.75 | $292.75 | $251.50 | $284.25 | $45.00 | $49.75 | $173.50 | $195.00 | $216.50 | $244.25 |
| 72 | $264.00 | $298.50 | $265.50 | $300.25 | $45.00 | $49.75 | $178.75 | $201.25 | $229.25 | $258.75 |
| 73 | $268.75 | $304.00 | $279.50 | $316.25 | $45.00 | $49.75 | $184.25 | $207.50 | $241.25 | $272.50 |
| 74 | $274.25 | $310.25 | $293.50 | $332.25 | $45.00 | $49.75 | $189.75 | $213.50 | $253.00 | $286.00 |
| 75 | $279.00 | $315.75 | $307.75 | $348.50 | $48.50 | $53.75 | $195.00 | $219.75 | $265.00 | $299.75 |
| 76 | $284.50 | $321.75 | $321.75 | $364.50 | $48.50 | $53.75 | $200.75 | $226.00 | $277.00 | $313.50 |
| 77 | $289.50 | $327.75 | $335.75 | $380.50 | $48.50 | $53.75 | $206.00 | $232.25 | $289.00 | $327.00 |
| 78 | $294.25 | $333.25 | $349.75 | $396.75 | $48.50 | $53.75 | $211.25 | $238.25 | $301.00 | $340.75 |
| 79 | $299.50 | $339.00 | $364.00 | $412.75 | $48.50 | $53.75 | $217.00 | $244.75 | $312.75 | $354.50 |
| 80+ | $304.75 | $345.25 | $378.00 | $428.75 | $48.50 | $53.75 | $222.50 | $251.00 | $324.75 | $368.00 |
Blue Medicare Supplement plans help cover the costs that Original Medicare doesn’t. Here’s how Plan G covers costs not covered by Original Medicare:
Be sure to take a look at the chart of all plans on pages 8–9 and select the one that works best for you
As you consider your Blue Medicare Supplement options, remember to consider your prescription drug needs, too. Medicare prescription drug coverage (also called Medicare Part D) plans are offered by private companies like Blue Cross NC.
To learn more about our Blue Medicare RxSM (PDP) plans, visit BlueCrossNC.com/Medicare or contact your local Blue Cross NC Authorized Independent Agent.
Blue365 offers access to savings on items that members may purchase directly from independent vendors, which are different from items that are covered under the policies with Blue Cross NC. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither Blue Cross NC nor BCBSA recommends, endorses, warrants, or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice.
TruHearing is a registered trademark of TruHearing, Inc. TruHearing is an independent company and does not offer Blue Cross or Blue Shield products or services. This program may change or be discontinued at any time. These fitness & hearing programs are not an insurance offering.
With some insurers, you can get locked into a plan that may not be right for you. But thanks to our exclusive Blue-to-Blue program, if your needs change over time, Blue Cross NC gives you the flexibility to switch Medicare plans:*
or contact your Blue Cross NC Authorized Independent Agent.
*Blue-to-Blue is only available when you switch from one Blue Cross NC Medicare plan to another Blue Cross NC Medicare plan. You may only switch during designated times of the year. Certain other limits apply.
Blue365 brings you great discounts on a wide variety of products and services. You’ll find savings on just about every aspect of a healthy, active life, including:
What’s more, all the Blue365 deals are delivered right to you. When you sign up, you’ll get deal alerts via email – so you’ll find it easy to take advantage of all the offers you’d like.
Blue365 offers access to savings on items that members may purchase directly from independent vendors, which are different from items that are covered under the policies with Blue Cross NC. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither Blue Cross NC nor BCBSA recommends, endorses, warrants, or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice.
SilverSneakers is more than a traditional fitness program. It’s a way to improve your health and live the life you want.
In the gym
At home or on the go
In your community
Always talk with your doctor before starting an exercise program.
1. Participating locations (PL) are not owned or operated by Tivity Health, Inc. or its affiliates. Use of PL facilities and amenities is limited to terms and conditions of PL basic membership. Facilities and amenities vary by PL. Inclusion of specific PLs is not guaranteed and PL participation may differ by health plan.
2. Membership includes SilverSneakers instructor-led group fitness classes. Some locations offer members additional classes. Classes vary by location.SilverSneakers is a registered trademark of Tivity Health, Inc. © 2025 Tivity Health, Inc. All rights reserved. SilverSneakers is an independent company and does not offer Blue Cross or Blue Shield products or services.
TruHearing offers routine exams and discounted prescription hearing aids (one per ear, per year).
As part of the program, a TruHearing provider will consult with you to determine the best type and style of hearing aid to address your lifestyle and unique hearing needs. If you are experiencing hearing loss, we hope you’ll take advantage of this program.
TruHearing is a registered trademark of TruHearing, Inc. TruHearing is an independent company and does not offer Blue Cross or Blue Shield products or services. This program may change or be discontinued at any time.
Like most health plans, Blue Medicare Supplement plans have some limitations
and exclusions. For example, Blue Cross NC does not provide benefits for
services, supplies, or charges that are: Not Medicare-eligible expenses under
the Medicare program unless otherwise noted; incurred prior to the effective
date of coverage, including any expenses when a subscriber is an inpatient on
the effective date of coverage; and payable under Medicare.
This brochure contains a summary of benefits that only describes our policy’s
most important features. You must read the policy itself to understand all
the rights and duties of both you and your insurance company. This brochure
and Outline of Coverage are not an insurance policy. The Blue Medicare
Supplement policy is the insurance contract. If there is any difference between
this brochure and the policy, the provisions of the policy will control.
Once you enroll in a plan, you will receive a Benefit Booklet that will contain
detailed information about plan benefits, exclusions, and limitations. You will
be notified 45 days in advance of any change in rates. The new rate will be
guaranteed for 12 months.
