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Important Legal Information and Disclaimers

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

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Blue Medicare HMO Frequently Asked Questions



Q: What happens to my Medicare coverage when I join a Blue Medicare HMO or Blue Medicare PPO plan? top

A: Once you become a Blue Medicare HMO or Blue Medicare PPO member, you transfer the administration of your Medicare benefits to Blue Medicare HMO or Blue Medicare PPO. This means you maintain your status as a Medicare beneficiary, plus gain the enhanced coverage available through your Blue Medicare HMO or Blue Medicare PPO health plan. You will receive a Blue Medicare HMO or Blue Medicare PPO Member ID card that you will present when using your Blue Medicare HMO or PPO benefits. You should present your Blue Medicare HMO or PPO ID card when using your pharmacy benefits. You are still responsible for paying your Medicare Part B premium.

Q: Are annual physicals covered? top

A: Yes, Blue Medicare HMO and Blue Medicare PPO recognize the importance of preventive care and encourage routine health examinations for all members.

Q: What happens if I have a medical emergency? top

A: If you have a medical emergency, go to the nearest medical facility or call 911. Blue Medicare HMO and Blue Medicare PPO plans cover eligible emergency services for you in or out of the service area. Please contact your primary care physician or Blue Medicare HMO or Blue Medicare PPO within 48 hours so your PCP can coordinate follow-up care. Emergency services require a copayment, but it will be waived if you are admitted to the hospital on an inpatient basis within 48 hours.

Q: If I'm a military retiree, can I join a Blue Medicare HMO or Blue Medicare PPO plan without losing my military benefits? top

A: Yes. Once you join Blue Medicare HMO or Blue Medicare PPO, you can continue to use your military benefits at military facilities and your Blue Medicare HMO or Blue Medicare PPO benefits outside of the military system.

Q: Can I qualify for financial assistance if I have a limited income? top

A: If you have Medicare and Medicaid, you already qualify for low income assistance. If you don't qualify for Medicaid, you may still qualify for some assistance. The amount of assistance will depend on your income and resources and will be applied to the cost of the Medicare prescription drug coverage portion of your Blue Medicare HMO or PPO plan. You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call 1-800-MEDICARE (1-800-633-4227). Hearing and speech impaired users should call 1-877-486-2048 (TTY/TDD), 24 hours a day/7 days a week or The Social Security Administration at 1-800-772-1213 between 7:00 a.m. and 7:00 p.m., Monday - Friday. Hearing and speech impaired users should call 1-800-325-0778 (TTY/TDD) or your State Medicaid Office.

If you do qualify for additional assistance for your Medicare prescription drug coverage costs, the amount of your premium and cost at the pharmacy will be lower. Once you have enrolled in a Blue Medicare HMO or Blue Medicare PPO plan, Medicare will tell us how much assistance you are receiving and we will send you information on the amount you will pay.

Q: Can I buy a stand-alone Medicare prescription drug plan from BCBSNC? top

A: Yes, but if you enroll in a Medicare Advantage plan and want Medicare prescription drug coverage, you must enroll in a Medicare Advantage prescription drug plan - one that includes both medical and prescription drug benefits.

Q: If I choose the Blue Medicare HMO plan that does not include Medicare prescription drug coverage, can I buy separately from another source? top

A: No. If you choose to enroll in the Blue Medicare HMO Medical only plan that does not include prescription drug coverage, federal regulations prohibit you from purchasing a separate Medicare prescription drug plan as a separate policy or from another company.

Q: Can I use my Medicare prescription drug coverage to order my drugs from Canada? top

A: No. Only drugs purchased in the United States are eligible for Medicare prescription drug coverage.

Q: Is Blue Medicare HMO a Medicare Supplement policy?top

A: No, a Medigap (Medicare Supplement) policy fills the gaps in Original Medicare Plan coverage. If you join a Medicare Advantage Plan, you'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Blue Cross and Blue Shield of North Carolina and not Original Medicare.

Q: What is a "Welcome to Medicare" Physical with Original Medicare vs. a BCBSNC Annual Physical?top

A: You can get this introductory visit only within the first 12 months you have Part B. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including certain screenings, shots, and referrals for other care. BCBSNC covers an annual physical with your Primary Care Physician every 12 months.



Important Legal Information and Disclaimers

The information on this page is current as of 10/1/2014.

Y0079_6741 CMS Approved 10022014