Medicare HMO coverage options
Making the right health care choices for yourself and your family is important. This includes selecting the plan that works best for you when you enroll. Remember to consider both your contributions (the amount you pay for coverage) and your out-of-pocket costs when you receive care. Start by reviewing the Medicare HMO summary information below as well as the Medicare PPO coverage options. Then use the online tools available through the Dow U.S. Benefits Site to review contributions and compare options based on your personal situation.
If you are a Dow Corning retiree
Please contact Alight regarding Medicare coverage options and costs:
(888) 628-0082 | retiree.alight.com/dowcorning
Note: Grandfathered Dow Corning retirees currently enrolled in Dow coverage can find plan details through the Dow U.S. Benefits Site.
In-network medical benefits
The summary below covers in-network benefits, which are generally the most cost-effective way to receive care. Note that HMOs require the use of in-network providers for care.
Coverage option
Blue Care Network of Michigan
Humana Health Plan of LA
Kaiser Foundation Health Plan, Inc.
Eligibility (based on heritage company you retired under)
Dow, Union Carbide, Rohm & Haas, Electronic Materials
Dow, Union Carbide, Rohm & Haas, Electronic Materials
Dow, Union Carbide, Rohm & Haas, Electronic Materials
Availability
Michigan
Louisiana
California
What you pay for care
Preventive care
◄ Covered 100% when you use in-network providers (no deductible) ►
Office visit copays (no deductible)
Primary care: $20
Specialist: $20
Primary care: $5
Specialist: $20
Primary care: $15
Specialist: $15
Telemedicine
Same as office visit copays
Same as office visit copays
$0 copay
Other copays (no deductible)
Urgent care: $20
Emergency room: $50
Outpatient x-ray/lab: $0
Outpatient surgery: $0
Outpatient mental health and substance abuse: $0
Inpatient care: $0
Note: Prior-authorization required for mental health and substance abuse
Urgent care: $20
Emergency room: $65
Outpatient x-ray/lab: $0
Outpatient surgery: $100
Outpatient mental health and substance abuse: $5 to $40
Inpatient care: $150 per day for 5 days
Note: 190-day lifetime limit in psychiatric facility
Urgent care: $15
Emergency room: $50
Outpatient x-ray/lab: $0
Outpatient surgery: $150
Outpatient mental health and substance abuse: $15 (lower for group visit)
Inpatient care: $100 per admission
Deductible (per member)
None
None
None
Coinsurance (after deductible)
N/A
N/A
N/A
Out-of-pocket maximum (per member)
$6,700
$2,500
$1,000
Additional details (including other benefits such as maternity, hospital, mental health and substance use, as well as out-of-network coverage, if applicable)
Review detailed carrier summary
Contact information and apps
Blue Care Network of Michigan
- Eligibility (based on heritage company you retired under): Dow, Union Carbide, Rohm & Haas, Electronic Materials
- Availability: Michigan
- Contribution amount (see details): $$
What you pay for care
- Preventive care: Covered 100% when you use in-network providers (no deductible)
- Office visit copays (no deductible): Primary care: $20 | Specialist: $20
- Telemedicine: Same as office visit copays
- Other copays (no deductible): Urgent care: $20 | Emergency room: $50 | Outpatient x-ray/lab: $0 | Outpatient surgery: $0 | Outpatient mental health and substance abuse: $0 | Inpatient care: $0| Note: Prior-authorization required for mental health and substance abuse
- Deductible (per member): None
- Coinsurance (after deductible): N/A
- Out-of-pocket maximum (per member): $6,700
Additional details (including other benefits such as maternity, hospital, mental health and substance use, as well as out-of-network coverage, if applicable)
- Review detailed carrier summary: Blue Care Network of Michigan
- Contact information and apps: bcbsm.com | (800) 450-3680 | Apple App Store | Google Play
Humana Health Plan of LA
- Eligibility (based on heritage company you retired under): Dow, Union Carbide, Rohm & Haas, Electronic Materials
- Availability: Louisiana
- Contribution amount (see details): $$
What you pay for care
- Preventive care: Covered 100% when you use in-network providers (no deductible)
- Office visit copays (no deductible): Primary care: $5 | Specialist: $20
- Telemedicine: Same as office visits copays
- Other copays (no deductible): Urgent care: $20 | Emergency room: $65 | Outpatient x-ray/lab: $0 | Outpatient surgery: $100 | Outpatient mental health and substance abuse: $5 to $40 | Inpatient care: $150 per day for 5 days | Note: 190-day lifetime limit in psychiatric facility
- Deductible (per member): None
- Coinsurance (after deductible): N/A
- Out-of-pocket maximum (per member): $2,500
Additional details (including other benefits such as maternity, hospital, mental health and substance use, as well as out-of-network coverage, if applicable)
- Review detailed carrier summary: Humana Health Plan of LA
- Contact information and apps: humana.com | (866) 396-8810 | Apple App Store | Google Play
Kaiser Foundation Health Plan, Inc.
- Eligibility (based on heritage company you retired under): Dow, Union Carbide, Rohm & Haas, Electronic Materials
- Availability: California
- Contribution amount (see details): $$
What you pay for care
- Preventive care: Covered 100% when you use in-network providers (no deductible)
- Office visit copays (no deductible): Primary care: $15 | Specialist: $15
- Telemedicine: $0 copay
- Other copays (no deductible): Urgent care: $15 | Emergency room: $50 | Outpatient x-ray/lab: $0 | Outpatient surgery: $150 | Outpatient mental health and substance abuse: $15 (lower for group visit) | Inpatient care: $100 per admission
- Deductible (per member): $150
- Coinsurance (after deductible): You pay 4%
- Out-of-pocket maximum (per member): $3,400
Additional details (including other benefits such as maternity, hospital, mental health and substance use, as well as out-of-network coverage, if applicable)
- Review detailed carrier summary: Kaiser Foundation Health Plan, Inc.
- Contact information and apps: kaiserpermanente.org | (855) 344-2209 | Apple App Store | Google Play
Prescription drug coverage
All of the medical plans include coverage for prescription medications. To help you save money, remember that generic drugs typically cost significantly less than brand-name medications while offering the same effectiveness. Additionally, using mail-order pharmacy services for maintenance medications can often lead to further savings and added convenience.
Coverage option
Blue Care Network of Michigan
Humana Health Plan of LA
Kaiser Foundation Health Plan, Inc.
What you pay for prescriptions
Deductible
None
None
None
Out-of-pocket maximums (per member)
$2,100
$2,100
$2,100
Retail (30-day supply)
Generic
You pay 50% up to max:
- Preferred pharmacy: $2
- Other pharmacy: $10
You pay $10 (low-cost generics only)
You pay based on supply:
- $10 for 30-day
- $20 for 31--60 day
- $30 for 61-100 day
Preferred brand name on formulary
You pay 50% up to max:
- Preferred pharmacy: $10
- Other pharmacy: $20
You pay $20 (level two) to $40 (level three)
Note: Amounts also apply to high-cost generics
You pay based on supply:
- $20 for 30-day
- $40 for 31-60 day
- $60 for 61-100 day
Non-preferred brand name
You pay 50% up to max:
- Preferred pharmacy: $30
- Other pharmacy: $40
You pay 25% (specialty medications)
Not covered/available
Mail order (90-day supply)
Generic
You pay 50% up to max:
- Preferred pharmacy: $4
- Other pharmacy: $20
You pay $0 (low-cost generics only)
You pay based on supply:
- $10 for 30-day
- $20 for 31-100 day
Preferred brand name on formulary
You pay 50% up to max:
- Preferred pharmacy: $20
- Other pharmacy: $40
You pay $40 (level two) to $80 (level three)
Note: Amounts also apply to high-cost generics
You pay based on supply:
- $20 for 30-day
- $40 for 31-100 day
Non-preferred brand name
You pay 50% up to max:
- Preferred pharmacy: $60
- Other pharmacy: $80
Not covered/available
Not covered/available
Blue Care Network of Michigan
What you pay for prescriptions
- Deductible: None
- Out-of-pocket maximum (per member): $2,100
- Retail (30-day supply):
- Generic: You pay 50% up to max: Preferred pharmacy: $2 | Other pharmacy: $10
- Preferred brand name on formulary: You pay 50% up to max: Preferred pharmacy: $10 | Other pharmacy: $20
- Non-preferred brand name: You pay 50% up to max: Preferred pharmacy: $30 | Other pharmacy: $40
- Mail order (90-day supply):
- Generic: You pay 50% up to max: Preferred pharmacy: $4 | Other pharmacy: $20
- Preferred brand name on formulary: You pay 50% up to max: Preferred pharmacy: $20 | Other pharmacy: $40
- Non-preferred brand name: You pay 50% up to max: Preferred pharmacy: $60 | Other pharmacy: $80
Humana Health Plan of LA
What you pay for prescriptions
- Deductible: None
- Out-of-pocket maximum (per member): $2,100
- Retail (30-day supply):
- Generic: You pay $10 (low-cost generics only)
- Preferred brand name on formulary: You pay $20 (level two) to $40 (level three) | Note: Amounts also apply to high-cost generics
- Non-preferred brand name: You pay 25% (specialty medications)
- Mail order (90-day supply):
- Generic: You pay $0 (low-cost generics only)
- Preferred brand name on formulary: You pay $40 (level two) to $80 (level three) | Note: Amounts also apply to high-cost generics
- Non-preferred brand name: Not covered/available
Kaiser Foundation Health Plan, Inc.
What you pay for prescriptions
- Deductible: None
- Out-of-pocket maximum (per member): $2,100
- Retail (30-day supply):
- Generic: You pay based on supply: $10 for 30-day | $20 for 31-60 day | $30 for 61-100 day
- Preferred brand name on formulary: You pay based on supply: $20 for 30-day | $40 for 31--60 day | $60 for 61-100 day
- Non-preferred brand name: Not covered/available
- Mail order (90-day supply):
- Generic: You pay based on supply: $10 for 30-day | $20 for 31-100 day
- Preferred brand name on formulary: You pay based on supply: $20 for 30-day | $40 for 31-100 day
- Non-preferred brand name: Not covered/available
Retiree contributions for 2026
The amount you pay to have medical coverage depends on a number of factors, including heritage company you retired under, the coverage tier you elect and years of service. To see the specific contributions that apply to you:
- Enroll through the Dow U.S. Benefits Site.
OR
- Review your benefits enrollment statement (mailed to you prior to enrollment).
Retired from Dow or Union Carbide?
You can also use the online calculators to estimate your Medicare contributions:
If you are a Dow Corning retiree
Please contact Alight regarding Medicare coverage options and costs:
(888) 628-0082 | retiree.alight.com/dowcorning
Note: Grandfathered Dow Corning retirees currently enrolled in Dow coverage can find plan details through the Dow U.S. Benefits Site.
The brief summaries of benefits in this communication are not intended to be complete descriptions of each of the respective benefit plans. If there are discrepancies between (a) information in this communication and any oral or written representations made by anyone regarding a plan and (b) the Summary Plan Descriptions (SPD) and other legal documents of any of the plans, the SPD and other legal documents will govern. Dow reserves the right to amend, modify, and terminate the plans described in this communication at any time in its sole discretion.
Content Steward: Dow North America Benefits | (800) 344-0661
October 2025