Blue Medicare HMO, Blue Medicare PPO, and Blue Medicare Rx (PDP) Members
My Benefits
Blue Medicare HMO and Blue Medicare PPO
Monthly Plan Premium for People who get Extra Help from Medicare to
Help Pay for their Prescription Drug Costs
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.
This table shows you what your monthly plan premium will be if you get extra help.
2013 LIS Table
| Your level of extra help | Monthly Premium for Blue Medicare HMO Standard* |
Monthly Premium for Blue Medicare HMO Enhanced* |
Monthly Premium for Blue Medicare PPO Enhanced* |
Monthly Premium for Blue Medicare PPO Enhanced Freedom* |
|---|---|---|---|---|
| 100% | $0.00 | $0.00 | $15.20 | $77.60 |
| 75% | $0.00 | $4.10 | $23.20 | $85.60 |
| 50% | $0.00 | $8.20 | $31.20 | $93.60 |
| 25% | $0.00 | $12.30 | $39.20 | $101.60 |
*This does not include any Medicare Part B premium you may have to pay.
Blue Medicare HMO's and Blue Medicare PPO's premium includes coverage for both medical services and prescription drug coverage.
If you aren't getting extra help, you can see if you qualify by calling:
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213. TTY/TDD users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
If you have any questions, please call Customer Services at 1-888-310-4110, (TTY/TDD: 1-888-451-9957) from 8 a.m. to 8 p.m., 7 days a week.
In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan.
To address these situations, CMS created the best available evidence (BAE) policy in 2006. This policy requires sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.
Please click on the link to CMS’ website below for materials related to the CMS Best Available Evidence (BAE) policy.
http://www.cms.hhs.gov/prescriptiondrugcovcontra/17_best_available_evidence_policy.asp
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.
The information on this page is current as of 1/5/2013.
Y0079_6107 CMS Approved 01082013