Medical Benefits for Medicare-Eligible Members
The following table summarizes the health care benefits available to members or dependents who are Medicare-eligible, and reference to where more details can be found.
Health Care Benefits
Coverage Options
Medical Coverage
Anthem Blue Cross-Administered Plans
  • Comprehensive Access Plan (CAP)
  • PG&E Medicare Supplemental Plan (MSP) [Members with Medicare only]
  • Retiree Optional Plan (ROP)
Health Maintenance Organizations (HMOs)
(Available if you live within the HMO's service territory)
  • Blue Shield Medicare COB HMO
  • Health Net COB HMO
Medicare Advantage HMOs
  • Health Net Seniority Plus
  • Kaiser Senior Advantage – North and South
Mental Health and Substance Abuse
(automatically included with medical coverage)
For Comprehensive Access Plan (CAP) Plan Members Only:
  • Coverage provided through the Mental Health and Substance Abuse Program, administered by ValueOptions (VO)
For PG&E Medicare Supplemental Plan (MSP) Members:
  • Only inpatient hospitalization for mental health conditions is covered by MSP
  • Outpatient mental health not covered
  • Substance abuse treatment not covered
For Retiree Optional Plan (ROP) Members:
  • Coverage provided through Anthem Blue Cross
For Health Net Seniority Plus Members:
  • Mental health coverage provided through your HMO, except for Substance Abuse, which is covered through ValueOptions (VO).
For Kaiser Senior Advantage Members:
  • Mental health coverage provided through your HMO, except for Inpatient Substance Abuse, which is covered through ValueOptions (VO).
For Members of Blue Shield COB HMO and Health Net COB HMO:
  • Mental health coverage provided through your HMO, except for Substance Abuse which is covered through ValueOptions (VO).
  • Call the HMO's member services number for details.
  • Substance abuse treatment provided through the Mental Health and Substance Abuse Program administered by ValueOptions (VO), and also through your HMO.
Prescription Drugs
(included with medical plan)
For Members of Anthem Blue Cross-Administered Plans:
  • Express Scripts (formerly Medco) (retail)
  • Express Scripts Mail Order (formerly Medco Health Home Delivery Pharmacy) (mail-order)
    No Home Delivery Pharmacy Service for the PG&E Medicare Supplemental Plan
For Members of HMOs:
  • Medicare Part D Plans; prescription drug coverage (retail and mail-order) through individual HMO plan (call the HMO's member services number for details)
If You Are Medicare-Eligible, But an Enrolled Dependent Is Not
If any of the dependents you cover are under age 65 and not Medicare-eligible, they will be enrolled in the under-65 version of the plan you are in, as indicated below, and if available in your area based on your home ZIP code.
If you are enrolled in:
Your dependent(s) not Medicare-Eligible will be enrolled in:
Blue Shield Medicare COB HMO
Blue Shield HMO
Health Net Medicare COB HMO or Health Net Seniority Plus (Medicare Advantage HMO)
Health Net HMO
Kaiser Senior Advantage (Medicare Advantage HMO)
Kaiser HMO
Comprehensive Access Plan (CAP)
or
PG&E Medicare Supplemental Plan (MSP)
Network Access Plan (NAP) or Comprehensive Access Plan (CA)
(depending upon where you live)
Retiree Optional Medical Plan
Retiree Optional Medical Plan
If You and a Dependent Are Both Medicare-Eligible
If you are enrolled in an Anthem Blue Cross plan and any of the dependents you cover are also Medicare-eligible, you and your Medicare-eligible dependent(s) must be enrolled in the same Anthem Blue Cross-administered plan. For example, if you are enrolled in the Comprehensive Access Plan (CAP), your Medicare-eligible dependent cannot be enrolled in the PG&E Medicare Supplemental Plan (MSP).