BlueCross BlueShield of North Carolina

Blue Medicare HMOSM

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If you're looking for 2015 plans, visit our 2015 Plans page. Plans listed are not available in all areas.

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After 12/31/14, we will no longer offer Blue Medicare HMO Standard and Blue Medicare HMO Enhanced in your county. Please visit our 2015 plans to select a plan for 1/1/2015.

Blue Medicare HMO, one of our Medicare Advantage plans, provides coverage for:

  • Inpatient/outpatient services
  • Skilled nursing facility care
  • Home health care
  • Worldwide emergency medical care
  • Ambulance and urgent care
  • Preventive care

Blue Medicare HMO (Health Maintenance Organization) is a Medicare Advantage plan that provides your care and services from doctors and hospitals that are within the plan's network. It provides your Medicare Parts A and B coverage, while keeping your out-of-pocket costs lower.

It also includes:

  • $0 monthly premium plans available 1
  • Health care benefits and Medicare prescription drug coverage combined in one plan2
  • No referral needed to see a specialist
  • Predictable copayments and costs
  • Fill your prescriptions at participating pharmacies throughout the state, including most of the major chain pharmacies, or through our mail order prescription program
  • Additional savings with our Preferred Pharmacy network (includes CVS, Kerr Drugs, Walmart and Epic pharmacies)

Blue Medicare HMO has three different plans: Standard, Medical Only and Enhanced. While each share similar features, there are differences in the amounts you pay for things such as copayments and inpatient hospital stays. Look at a side-by-side comparison of our Blue Medicare HMO plans.

Is Blue Medicare HMO Available in Your Area?

Our service area map can show you if Blue Medicare HMO is available in your county.

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  1. Rate is for Blue Medicare HMO Standard and Blue Medicare HMO Medical-Only plans, 2014.
  2. A formulary applies for all plans that include Medicare prescription drug coverage.

®, SM Marks of the Blue Cross and Blue Shield Association.

Important Legal Information and Disclaimers

U9404, 10/14

The information on this page is current as of 10/01/2014.

Y0079_6741 CMS Approved 10022014

How do the different Blue Medicare HMO plans work? What about Part D prescription drug benefits?

The following charts can help answer those questions by comparing Blue Medicare HMO plans (Standard, Medical Only and Enhanced), as well as Part D Benefits for Blue Medicare HMO.1

Compare Plans

Medical-Only Standard Enhanced
Monthly Member Premium2,3 $0 $0 $18.90
Features
  • Includes our most robust medical benefits
  • Includes basic medical benefits
  • Standard drug coverage included
  • Includes our most robust medical benefits
  • Enhanced prescription drug coverage included
Provider choice
  • In-network benefits only
  • Must use a network provider
  • In-network benefits only
  • Must use a network provider
  • In-network benefits only
  • Must use a network provider
Primary care physician office visits4
  • $5 copayment for in-network visits only
  • $15 copayment for in-network visits only
  • $10 copayment for in-network visits only
Inpatient hospital stay per day
  • $100, Up to 7 days
  • $220, Up to 7 days
  • $170, Up to 7 days
Medicare prescription drug benefit
  • None
  • Includes our standard drug benefit
  • No deductible
  • You pay the following up to $2850 out-of-pocket
  • Includes our enhanced drug benefit
  • No deductible
  • You pay the following up to $2850 out-of-pocket
During the coverage gap
  • None
  • 72% on all generics
  • a discount on brand name drugs until your yearly out-of-pocket drug costs reach $4,550
  • $3 for preferred pharm
  • $8 for non-preferred pharm
  • 72% on all other generics
  • a discount on brand name drugs until your yearly out-of-pocket drug costs reach $4,550
Catastrophic Coverage
  • None
  • You pay 5%
  • After you reach $4,550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand name or 5% of the total drug cost.
  • You pay 5%
  • After you reach $4,550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand name or 5% of the total drug cost.
Monthly Member Premium 2,3
Medical-Only $0
Standard $0
Enhanced $18.90
Features
Medical-Only
  • Includes our most robust medical benefits
Standard
  • Includes basic medical benefits
  • Standard drug coverage included
Enhanced
  • Includes our most robust medical benefits
  • Enhanced prescription drug coverage included
Provider Choice
Medical-Only
  • In-network benefits only
  • Must use a network provider
Standard
  • In-network benefits only
  • Must use a network provider
Enhanced
  • In-network benefits only
  • Must use a network provider
Primary care physician office visits4
Medical-Only
  • $5 copayment for in-network visits only
Standard
  • $15 copayment for in-network visits only
Enhanced
  • $10 copayment for in-network visits only
Inpatient hospital stay per day
Medical-Only
  • $100, Up to 7 days
Standard
  • $220, Up to 7 days
Enhanced
  • $170, Up to 7 days
Medicare prescription drug benefit
Medical-Only
  • None
Standard
  • Includes our standard drug benefit
  • No deductible
  • You pay the following up to $2850 out-of-pocket
Enhanced
  • Includes our enhanced drug benefit
  • No deductible
  • You pay the following up to $2850 out-of-pocket
During the coverage gap
Medical-Only
  • None
Standard
  • 72% on all generics
  • a discount on brand name drugs until your yearly out-of-pocket drug costs reach $4,550
Enhanced
  • $3 for preferred pharm
  • $8 for non-preferred pharm
  • 72% on all other generics
  • a discount on brand name drugs until your yearly out-of-pocket drug costs reach $4,550
Catastrophic Coverage
Medical-Only
  • None
Standard
  • You pay 5%
  • After you reach $4,550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand name or 5% of the total drug cost.
Enhanced
  • You pay 5%
  • After you reach $4,550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand name or 5% of the total drug cost.

View a side-by-side comparison of Blue Medicare HMO and Blue Medicare PPO

Compare Part D Benefits

Medicare offers prescription drug (Part D) coverage, as part of most Medicare Advantage plans, to help you pay for your prescription drugs. With this coverage, you can fill your prescriptions at participating pharmacies close to where you live, or through our convenient mail-order pharmacy services.4 You'll have greater savings using our Preferred Pharmacy network, which includes CVS, Walmart, Kerr and Epic pharmacies.

Part D coverage is available with most Blue Medicare HMO plans. That means you can have your medical benefits and prescription drug coverage in one plan, for one premium.

How much will your prescription drugs cost you? Here's what you could expect to pay for a 30-day prescription supply, depending on where you to to purchase your prescription drugs:

Preferred Retail Pharmacy
(CVS, Walmart, Kerr & Epic)
Non-Preferred Retail Pharmacy Preferred Mail Order Service
Drug List Tiers HMO Standard HMO Enhanced HMO Standard HMO Enhanced HMO Standard HMO Enhanced
Tier 1 - Preferred Generic Drugs $3 $3 $8 $8 $3 $3
Tier 2 - Non-Preferred Generic Drugs $6 $6 $25 $20 $6 $6
Tier 3 - Preferred Brand-Name Drugs $40 $30 $45 $45 $40 $30
Tier 4 - Non-Preferred Brand-Name Drugs $80 $70 $95 $95 $80 $70
Tier 5 - Specialty Drugs 33% 33% 33% 33% 33% 33%

You pay the copayment per 30-day supply or coinsurance until your drugs, and the plan pays the remainder until the total drug costs reach $2850.

After your total yearly drug costs reach $2850, you have reached the Coverage Gap: you receive limited coverage on certain drugs and pay the following:

Preferred Retail Pharmacy
(CVS, Walmart, Kerr & Epic)
Non-Preferred Retail Pharmacy Preferred Mail Order Service
HMO Standard HMO Enhanced HMO Standard HMO Enhanced HMO Standard HMO Enhanced
Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs For Tier 1, preferred generics, you pay $3. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs. Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs For Tier 1, preferred generics, you pay $8. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs. Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs For Tier 1, preferred generics, you pay $3. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs.

After you reach $4550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand-name or 5% of the total drug costs.

How much will your prescription drugs cost you? Here's what you could expect to pay for a 30-day prescription supply, depending on where you to to purchase your prescription drugs:

Preferred Retail Pharmacy
(CVS, Walmart, Kerr & Epic)
HMO Standard HMO Enhanced
Tier 1 - Preferred Generic Drugs $3 $3
Tier 2 - Non-Preferred Generic Drugs $6 $6
Tier 3 - Preferred Brand-Name Drugs $40 $30
Tier 4 - Non-Preferred Brand-Name Drugs $80 $70
Tier 5 - Specialty Drugs 33% 33%
Non-Preferred Retail Pharmacy
HMO Standard HMO Enhanced
Tier 1 - Preferred Generic Drugs $8 $8
Tier 2 - Non-Preferred Generic Drugs $25 $20
Tier 3 - Preferred Brand-Name Drugs $45 $45
Tier 4 - Non-Preferred Brand-Name Drugs $95 $95
Tier 5 - Specialty Drugs 33% 33%
Preferred Mail Order Service
HMO Standard HMO Enhanced
Tier 1 - Preferred Generic Drugs $3 $3
Tier 2 - Non-Preferred Generic Drugs $6 $6
Tier 3 - Preferred Brand-Name Drugs $40 $30
Tier 4 - Non-Preferred Brand-Name Drugs $80 $70
Tier 5 - Specialty Drugs 33% 33%

You pay the copayment per 30-day supply or coinsurance until your drugs, and the plan pays the remainder until the total drug costs reach $2850.

After your total yearly drug costs reach $2850, you have reached the Coverage Gap: you receive limited coverage on certain drugs and pay the following:

Preferred Retail Pharmacy
(CVS, Walmart, Kerr & Epic)
HMO Standard Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs
HMO Enhanced For Tier 1, preferred generics, you pay $3. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs.
Non-Preferred Retail Pharmacy
HMO Standard Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs
HMO Enhanced For Tier 1, preferred generics, you pay $8. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs.
Preferred Mail Order Service
HMO Standard Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs
HMO Enhanced For Tier 1, preferred generics, you pay $3. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs.

After you reach $4550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 fir brand-name or 5% of the total drug costs.

Drug List (Formulary) for Blue Medicare HMO

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  1. You must use the plan's providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor BCBSNC will be responsible for the costs.
  2. You must continue to pay the Medicare Part B premium in addition to your plan premium.
  3. Formulary applies for all plans that include Medicare prescription drug coverage.
  4. Beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.

Important Legal Information and Disclaimers

U9404a, 10/14

The information on this page is current as of 10/01/2014.

Y0079_6741 CMS Approved 10022014

To be eligible for Blue Medicare HMO, you must:

  1. Be entitled to Medicare Part A and enrolled in Medicare Part B.
  2. Live in the plan's service area. Make sure Blue Medicare HMO is available in your county.

Federal law states you may be ineligible to join Blue Medicare HMO if you have end-stage renal disease (ESRD), unless you qualify. Contact us for more information.

Enrollment Periods

Annual enrollment period (AEP): October 15 through December 7 of every year.
Annual disenrollment period: January 1 through February 14 of every year.

The initial coverage enrollment period begins three months immediately before you become eligible for both Medicare Part A and Part B and ends on the later of either:

  • The last day of the month preceding your eligibility to both Medicare Parts A and B, or
  • The last day of your Medicare Part B initial enrollment period.

Special Enrollment Periods

There are some limited situations where you could change outside of the AEP, October 15 – December 7 period. For example, if you moved out of your plan's service area, you'd have the chance to pick another plan based on your new location. Contact us for more information about this and other situations that qualify.

Delayed Enrollment

If you didn't enroll in Medicare Parts A, B or D coverage when you were first eligible, you may enroll during the AEP each year thereafter. You may also be eligible to enroll during a special enrollment period, depending on your situation. For Part D, you may have to pay a late enrollment penalty premium.

Give us a call at 1-800-665-8037, 7 days a week, 8 a.m.-8 p.m. to learn more. TTY/TDD users, call 1-800-922-3140.

Get Started Remind Me

While everyone with Medicare is eligible for Part D coverage, you're not required to have Part D. But, if you don't enroll in Part D when you first become eligible, you may have to pay more for prescription drug coverage if you decide to enroll later.

Important Legal Information and Disclaimers

U9494b, 10/14

The information on this page is current as of 10/01/2014.

Y0079_6741 CMS Approved 10022014

If you enroll in a Medicare Advantage plan that includes Part D, the Part D rules for eligibility apply to the drug portion of the Medicare Advantage Prescription Drug (MAPD) plan.

You have two choices when it comes to enrolling in a Blue Medicare HMO plan: online application or paper application. But before you pick how you enroll, you should first:

  • Choose a plan. After you've reviewed our plans, pick the one that best meets your needs. If you need help picking the right plan, we can help you choose.
  • Choose a doctor. If you don't already have a doctor, or a primary care physician (PCP), you can search for doctors available in the plan you select. If you need help, contact us.

The enrollment form will ask for your primary care phycian's PCP code (also known as NPI #). Please write it down to enter on your enrollment form.

Once you've picked a plan and a doctor, you can start enrolling in a Blue Medicare HMO plan.

Enroll Online

Enter and submit your enrollment form safely, quickly and easily:

Get Started Remind Me

Enroll by Paper

Blue Medicare HMO Enrollment
P.O. Box 17168
Winston-Salem, NC 27116

If you'd rather request the enrollment form to be mailed, or if you have enrollment questions, call us at 1-800-665-8037, seven days a week, 8 a.m. - 8 p.m. TTY/TDD users, call 1-800-922-3140.

We'll mail you an enrollment kit that includes the enrollment form, a Summary of Benefits document and additional plan information.

Additional Links for Blue Medicare HMO

Medical and Drug Plan Ratings for Blue Medicare HMO (pdf)

Multi-Language Intepreter Services (pdf)

Blue Medicare HMO Product Brochure (pdf)

Other Enrollment Options

You can also enroll in Blue Medicare HMO Standard, Blue Medicare HMO Enhanced or Blue Medicare HMO Medical Only through the CMS Medicare Online Enrollment Center.

Important Legal Information and Disclaimers

U9404c, 10/14

The information on this page is current as of 10/01/2014.

Y0079_6741 CMS Approved 10022014

You can enroll in Medicare Advantage plans only during specific times of the year. Enrollment dates are available at Medicare.gov or by calling 1-800-665-8037, 8 a.m. - 8 p.m., seven days a week (TDD/TYY: 1-800-922-3140).

To view PDF documents, you need to download and install Adobe Acrobat Reader on your computer.

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