Welcome to Blue Cross Medicare Advantage

Our goal is to help you manage your health. We’ll call to welcome you to the plan. We’d like to know if you have questions about your benefits or if you have other special needs that need immediate attention. During your welcome call:

✔ We’ll make sure you received your member ID card and Evidence of Coverage (EOC) in the mail. The EOC tells you how to get your medical care and prescription drugs covered through our plan. Review it and keep it in a safe place.

✔ We’ll ask you a few questions from a voluntary Health Questionnaire. The questions are easy to answer and will help us understand your needs. Based on your answers, we may reach out to you about your health to help you better manage it. We might suggest an in-home assessment with one of our care management professionals.

✔ We’ll help you schedule an Annual Wellness Exam.

✔ We’ll discuss the Healthy Action Rewards program.

You may have caller ID on your phone and may not recognize that your plan is calling you. Remember we’ll be calling, so be sure to answer.

We’d like to have your email address to send you communications about health plan benefits and programs throughout the year. We never share your email address outside the plan. You can always opt out or ask us to stop sending you emails.

You will receive an Annual Notice of Change in October. This notice outlines any expected premium/benefit changes for next year. These changes will begin January 1 of the following calendar year. Review this document carefully.

You will receive a statement called the Explanation of Benefits. How often you receive it depends on how often you fill your prescriptions. This statement is not a bill. It simply details what you have paid and indicates the level of benefits you’ve used. Review these to be sure they are correct. If you think there are errors, please contact us. If you think you are the victim of fraud, report it immediately.

Blue Cross Medicare Advantage covers a broad range of prescription drugs. The formulary may be different from what you’re used to, and it is always available to view online. Share the formulary with your doctor and talk about the drugs you take now. You may find you can save money by choosing generic drugs. Ask if this is an option for you.

In Medicare Advantage plans, prescription drugs are placed into tiers. The costs for drugs in each tier are different. Tier 1 drugs will cost less than Tier 5 drugs. The tiers are:

• Tier 1 — Preferred Generic Drugs
• Tier 2 — Generic Drugs
• Tier 3 — Preferred Brand Drugs
• Tier 4 — Non-Preferred Drugs
• Tier 5 — Specialty Drugs

Please read the formulary for more information about these rules and exceptions or visit the Prior Authorization/Utilization Management page for more information. 

To get the most from your benefits, you will use providers in our network. Your current doctors may be in the network. The network includes local primary care providers and a wide range of specialists. If you have an HMO plan, you must choose a primary care provider (PCP). In some cases, you may need care from a provider that is out of network, which may cost you more. If your current provider is not in the network, we can help you find a new one. Search for a provider.

Certain high cost medical services that have more cost-effective alternatives need prior authorization from the plan before your provider can proceed. Our plans follow government guidelines in this area to make sure you receive the most appropriate, cost-effective care available.