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Blue Medicare HMO, Blue Medicare PPO, and Blue Medicare Rx (PDP) Members

My Benefits

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Benefits Overview
  • Newly covered Services
    Please click here to see a list of new benefits.
  • SilverSneakers® 1
    Silver Sneakers Fitness ProgramThe SilverSneakers Fitness Program offers Blue Medicare HMO and Blue Medicare PPO members physical activity, health education and special social events.
  • Visiting the Doctor and Other Providers
    Your primary care physician (PCP) will coordinate your health care. You're not required to see your PCP before visiting a specialist, but it's strongly recommended so that your PCP is fully aware of the medical care you're receiving. Learn more about choosing a PCP and how to access your health care.
    • For Blue Medicare HMO, you must use plan providers, except in emergency/urgent care situations, or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers, neither Medicare nor Blue Medicare HMO are responsible for the costs.
    • Member liability with Blue Medicare PPO may be greater for services received out of network than services received in network. Many out-of-network services are subject to coinsurance, which is based on the Medicare allowed amount and not on the potentially lower contract amount. With the exception of emergency or urgent care, it may cost more to get care from non-plan or non-preferred providers.
  • Using Medicare Prescription Drug Coverage
    If your plan includes Medicare prescription drug coverage, learn how easy it is to fill your prescriptions at a local pharmacy or through mail order.
Available in Select Counties

Blue Medicare HMO and Blue Medicare PPO plans are available in the following counties:

HMO and Blue Medicare PPO Service Area

Alamance Caswell Franklin Iredell Northampton Rowan Waynes
Alexander Catawba Gaston Johnston Onslow Sampson Wilkes
Alleghany Chatham Gates Jones Orange Scotland Wilson
Anson Chowan Granville Lee Pamlico Stanly Yadkin
Ashe Cleveland Greene Lincoln Pender Stokes
Avery Columbus Guilford Madison Perquimans Surry
Beaufort Cumberland Halifax Martin Person Tyrrell
Bertie Davidson Harnett McDowell Pitt Union
Bladen Davie Haywood Mecklenburg Polk Vance
Brunswick Duplin Henderson Mitchell Randolph Wake
Cabarus Durham Hertford Montgomery Richmond Warren
Caldwell Edgecombe Hoke Nash Robeson Washington
Carteret Forsythe Hyde New Hanover Rockingham Watauga


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1 The SilverSneakers program is provided by Healthways, Inc., a third-party vendor independent of BCBSNC. The program is available only to members covered under Blue Medicare HMO or Blue Medicare PPO plans. BCBSNC is not liable in any way for the services received; results are not guaranteed. Decisions regarding medical care should be made with the advice of a doctor.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. Please contact BCBSNC for details.

Blue Cross Blue Shield of North Carolina (BCBSNC) is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. BCBSNC is a Medicare-approved Part D sponsor. BCBSNC does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All BCBSNC items and services are available to all eligible beneficiaries in the service area.

Limitations, copayments, and restrictions may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium.

If you would like Medicare Advantage or Part D documents in a different language or format, or your coverage has ended and you need proof of coverage or a Certification of Health Insurance Coverage, you can call us 7 days a week, 8a.m. to 8 p.m.

Blue Medicare HMO:
1-888-310-4110 (TDD/TYY 1-888-451-9957)
Blue Medicare PPO:
1-877-494-7647 (TDD/TYY 1-888-451-9957)
Blue Medicare Rx (PDP):
1-888-247-4142 (TDD/TYY 1-888-247-4145)

®, SM Marks of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina. ®1 Mark of Healthways, Inc.

The information on this page is current as of 1/5/2013.

Y0079_6107 CMS Approved 01082013