BlueCross BlueShield of North Carolina

FAQ

Blue Medicare HMO

Are annual physicals covered?

Yes, Blue Medicare HMO and Blue Medicare PPO recognize the importance of preventive care and encourage routine health examinations for all members. Members must select a Primary Care Provider (PCP) to coordinate care. For preventive care, your PCP must provide the primary care in order to be covered as a primary care visit.

How secure is the information I enter online?

BCBSNC has taken steps to protect information collected from our online visitors against unauthorized access and use. All online forms that include information captured from our users are secured using a Secured Socket Layer (SSL), which encrypts the information as it travels from the desktop to our server. BCBSNC is committed to ensuring transaction security and privacy. BCBSNC obtains certification from industry-recognized security vendors to ensure that our systems meet security standards. As an additional security measure, BCBSNC uses a firewall to prevent unauthorized access to our site. Site personnel monitor activity logs at regular intervals to look for unauthorized intrusions. For more information, view our Privacy Policy.

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

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 you gain the enhanced coverage available through your Blue Medicare HMO or Blue Medicare PPO health plan. You'll receive a Blue Medicare HMO or Blue Medicare PPO Member ID card that you'll 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.

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

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.

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

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've enrolled in a Blue Medicare HMO or Blue Medicare PPO plan, Medicare will tell us how much assistance you're receiving and we'll send you information on the amount you'll pay.

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

2014 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 $1.00 $16.50 $93.00
75% $0.00 $5.50 $21.90 $100.10
50% $0.00 $9.90 $27.20 $107.20
25% $0.00 $14.40 $32.60 $114.20

2013 LIS Table

Your level of extra help Monthly Premium for Blue Medicare HMO Standard*
100% $0.00
75% $0.00
50% $0.00
25% $0.00
Your level of extra help Monthly Premium for Blue Medicare HMO Enhanced*
100% $0.00
75% $4.10
50% $8.20
25% $12.30
Your level of extra help Monthly Premium for Blue Medicare PPO Enhanced*
100% $15.20
75% $23.20
50% $31.20
25% $39.20
Your level of extra help Monthly Premium for Blue Medicare PPO Enhanced Freedom*
100% $77.60
75% $85.60
50% $93.60
25% $101.60

2014 LIS Table

Your level of extra help Monthly Premium for Blue Medicare HMO Standard*
100% $0.00
75% $0.00
50% $0.00
25% $0.00
Your level of extra help Monthly Premium for Blue Medicare HMO Enhanced*
100% $1.00
75% $5.50
50% $9.90
25% $14.40
Your level of extra help Monthly Premium for Blue Medicare PPO Enhanced*
100% $16.50
75% $21.90
50% $27.20
25% $32.60
Your level of extra help Monthly Premium for Blue Medicare PPO Enhanced Freedom*
100% $93.00
75% $100.10
50% $107.20
25% $114.20
If I choose the Blue Medicare HMO plan that doesn't include Medicare prescription drug coverage, can I buy Medicare prescription drug coverage separately from another source?

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.

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

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

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

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.

What happens if I have a medical emergency?

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

Blue Medicare PPO

Are annual physicals covered?

Yes, Blue Medicare HMO and Blue Medicare PPO recognize the importance of preventive care and encourage routine health examinations for all members. Members must select a Primary Care Provider (PCP) to coordinate care. For preventive care, your PCP must provide the primary care in order to be covered as a primary care visit.

How secure is the information I enter online?

BCBSNC has taken steps to protect information collected from our online visitors against unauthorized access and use. All online forms that include information captured from our users are secured using a Secured Socket Layer (SSL), which encrypts the information as it travels from the desktop to our server. BCBSNC is committed to ensuring transaction security and privacy. BCBSNC obtains certification from industry-recognized security vendors to ensure that our systems meet security standards. As an additional security measure, BCBSNC uses a firewall to prevent unauthorized access to our site. Site personnel monitor activity logs at regular intervals to look for unauthorized intrusions. For more information, view our Privacy Policy.

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

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 you gain the enhanced coverage available through your Blue Medicare HMO or Blue Medicare PPO health plan. You'll receive a Blue Medicare HMO or Blue Medicare PPO Member ID card that you'll 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.

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

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.

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

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.

Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs

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

2014 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 $1.00 $16.50 $93.00
75% $0.00 $5.50 $21.90 $100.10
50% $0.00 $9.90 $27.20 $107.20
25% $0.00 $14.40 $32.60 $114.20

2013 LIS Table

Your level of extra help Monthly Premium for Blue Medicare HMO Standard*
100% $0.00
75% $0.00
50% $0.00
25% $0.00
Your level of extra help Monthly Premium for Blue Medicare HMO Enhanced*
100% $0.00
75% $4.10
50% $8.20
25% $12.30
Your level of extra help Monthly Premium for Blue Medicare PPO Enhanced*
100% $15.20
75% $23.20
50% $31.20
25% $39.20
Your level of extra help Monthly Premium for Blue Medicare PPO Enhanced Freedom*
100% $77.60
75% $85.60
50% $93.60
25% $101.60

2014 LIS Table

Your level of extra help Monthly Premium for Blue Medicare HMO Standard*
100% $0.00
75% $0.00
50% $0.00
25% $0.00
Your level of extra help Monthly Premium for Blue Medicare HMO Enhanced*
100% $1.00
75% $5.50
50% $9.90
25% $14.40
Your level of extra help Monthly Premium for Blue Medicare PPO Enhanced*
100% $16.50
75% $21.90
50% $27.20
25% $32.60
Your level of extra help Monthly Premium for Blue Medicare PPO Enhanced Freedom*
100% $93.00
75% $100.10
50% $107.20
25% $114.20
Can I use my Medicare prescription drug coverage to order my drugs from Canada?

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

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

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.

What happens if I have a medical emergency?

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

Blue Medicare Rx (PDP)

What drugs are covered under Blue Medicare Rx coverage?

Each plan provider will establish its own formulary, or list of prescription drugs, that it will cover. Although formularies must meet certain requirements set by Medicare, they still differ by plan.

Blue Medicare Rx coverage will include:

  • Prescription drugs
  • Most vaccines
  • Insulin
  • Certain medical supplies associated with the injection of insulin (syringes, needles, alcohol swabs and gauze)

Generally speaking, Blue Medicare Rx coverage covers drugs that meet the following criteria:

  • They must be available only by prescription
  • They must be approved by the Food and Drug Administration
  • They must be used and sold in the United States
  • They must be medically necessary
  • Certain drugs, or classes of drugs, will not be covered because they are excluded by law, such as over the counter medicines like aspirin.

To learn which drugs are covered by BCBSNC's Blue Medicare Rx Plans, search our drug list.

Will mail-order drugs be available through Blue Medicare Rx coverage?

You will have the convenient option of using a mail-order pharmacy. You can purchase up to a 90-day supply through mail order, and your medications will be delivered directly to your home. Depending on your plan, there may be savings available to you if you use the mail option.

Can I change plans when I want to?

Congress designed Medicare prescription drug coverage on an annual enrollment cycle. This means that each year, you will have the option to re-enroll in your existing Medicare prescription drug coverage plan or change plans between October 15 and December 7 each year.

You may also have another opportunity during the year to switch plans, under limited circumstances. For example, if you move out of your plan's service area, you'll have an opportunity to choose another plan that serves your new area.

What is the penalty for late enrollment?

The late penalty equals one percent of the premium amount for each month that enrollment is delayed. For example, if you delay enrollment in Blue Medicare Rx coverage for two years, you will pay an additional 24 percent on top of the premium each month.

Why is there a penalty for late enrollment?

The penalty was designed to encourage beneficiaries to enroll in Part D when they first become eligible. It helps hold down the overall costs of the drug program and is similar to the late penalty imposed for late enrollment in Medicare Part B.

Must I continue to pay my Medicare Part B premium?

Yes. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

What if I have a limited income?

If you have Medicare and have limited income and resources, you may qualify for special financial assistance to help you pay for your Blue Medicare Rx plan costs. The amount of assistance you qualify for will depend on your income and resources.

Beneficiaries interested in applying for extra help with Blue Medicare Rx Plan costs should call:

  • Medicare at 1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours a day, seven days a week.
  • Your state Medicaid office
  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday.TTY/TDD users should call 1-800-325-0778.

If you qualify for extra help with your Blue Medicare Rx Plan, your premium and drug costs will be lower. When you join BCBSNC, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay.

Blue Medicare Supplement

Will I have a waiting period for any pre-existing conditions?

Pre-existing conditions are conditions for which medical advice was given or treatment was recommended by or received from a doctor within six months of the effective date of coverage. The six month waiting period will be reduced by the amount of time you have spent under other health insurance coverage as long as the coverage is terminated no more than 63 days prior to your effective date.

Will my rates increase because I get older?

Yes. Attained-age plans have low initial rates that increase due to age and overall claim experience. Our rates will only increase due to age when you move from one age band to the next.1

What action should I take when I receive an explanation of benefits statement?

The explanation of benefits statement is not a bill. It is a notification that your claim has been processed and indicates any amounts paid, denied or owed by you to providers of care.

Is prescription drug coverage a benefit of any of the Blue Medicare Supplement Plans?
Prescription drug coverage is not included as a benefit of any Blue Medicare Supplement plan. On January 1, 2006, Medicare's prescription drug coverage became effective. Medicare Prescription Drug Coverage was designed by the U.S. Congress to help you pay for the prescription drugs you need. If you would like this prescription drug coverage, you must purchase it separately from your Medigap (Blue Medicare Supplement) health plan. Everyone with Medicare is eligible for this coverage. Beneficiaries are not automatically enrolled. You may choose to purchase this private insurance on an annual basis.

What if I have a drug discount card?

If you were enrolled in a Medicare-approved drug discount card plan, Medicare prescription drug coverage replaced that program as of January 1, 2006, and the discount card is no longer available. That's because the discount card program was intended to provide temporary assistance, until Medicare Prescription Drug Coverage was implemented.

  1. When you enroll in an attained-age plan, your rates will increase as you age. Our rates will only increase due to age when you move from one age band to the next. In addition, rate adjustments will also be due to medical inflation or overall claims experience. Rates are subject to change June 1 of each year and are guaranteed for 12 months. Any change in rate will be preceded by a 30-day notice. Members will not be singled out for premium increases based on their individual health. Medicare policies that are attained-age should be compared to issue-age rated policies. Premiums for issue-age policies do not increase due to age as the insured ages.

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/TTY: 1-800-922-3140).

Neither Blue Cross and Blue Shield of North Carolina nor its agents are endorsed by or affiliated with the United States government or the federal Medicare program.

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Important Legal Information and Disclaimers

U9422, 10/14

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

Y0079_6741 CMS Approved 10022014