Blue Medicare HMO gives you quality coverage within a large network of doctors and specialists. Our enhanced plan includes our most robust medical benefits and is available with or without prescription drug benefits. We also offer a standard benefit plan with standard prescription drug benefits. (You must continue to pay your Medicare Part B premium.)
Blue Medicare HMO is offered by Blue Cross and Blue Shield of North Carolina. Blue Medicare HMO is administered by BCBSNC. BCBSNC is a local company you can trust – with more than 70 years of experience in the health care industry.
Your retirees may visit doctors within Blue Medicare HMO's extensive network of contracted doctors and select a primary care physician (PCP) from within that network to coordinate your care. They can select a family practice, general practice or internal medicine doctor as their PCP.
Although it is not required that members visit a PCP before visiting a specialist, it is strongly encouraged. A PCP can help ensure that members receive coordinated health care when referring them for tests, hospital stays or specialist consultations.
There is no penalty for visiting a specialist without a referral from a PCP. However, the cost of a specialist visit is greater than the cost of a PCP visit. A PCP can help ensure that members need a specialist visit.
If a member sees a doctor outside the network, except in an emergency or urgent care situations or for out-of-area renal dialysis, neither Medicare nor BCBSNC will be responsible for the costs.
Members can fill their prescriptions at a large network of participating pharmacies throughout North Carolina. Most of the major chain pharmacies are part of the network, and members can fill their prescriptions at any of the chain locations nationwide. Members can also fill their prescriptions through the mail order prescription program, which uses one of the largest network mail order pharmacies in the country.
Blue Medicare HMO offers three plans, two with different Medicare prescription drug benefits. The enhanced HMO plan includes enhanced drug benefits, and the standard HMO plan includes standard drug benefits. The Medical only plan has enhanced medical benefits but does not include Medicare prescription drug benefits.
Standard drug benefit
Blue Medicare HMO standard plan includes Medicare’s "standard benefit" drug benefits. Companies may offer additional enhanced coverage, but they must offer a standard prescription drug benefit that is at least equal in value to Medicare’s standard drug benefit. This benefit covers generic, brand–name and specialty drugs and has a $275 deductible.
Enhanced drug benefit
Blue Medicare HMO enhanced plan includes more comprehensive prescription drug coverage than the standard plan. It covers the same generic, brand–name and specialty prescription drugs as the standard plan — but with no deductible! It also includes covered generic prescription drugs in the coverage gap.
NOTE: The Centers for Medicare & Medicaid Services (CMS) classify the Blue Medicare HMO as a Medicare Advantage prescription drug plan because it includes medical coverage and prescription drug coverage. Blue Cross and Blue Shield of North Carolina also offers stand–alone Medicare prescription drug plans — without medical coverage. You cannot enroll in a Medicare Advantage prescription drug plan and enroll in a stand–alone Medicare prescription drug plan at the same time.
Blue Medicare HMO is available to employer groups in select counties across North Carolina within the service area approved by the Centers for Medicare & Medicaid Services (CMS).
Blue Medicare HMO offers a variety of health and wellness resources for members.
Health management programs
These programs are designed for people with specific chronic conditions, including:
The programs feature an array of resources to help participants manage their condition. Each program includes educational materials, support from registered nurses, self–management supplies and more.
In certain health situations, members are eligible to work one–on–one with a case manager. A case manager can coordinate a member’s care, help navigate the health system, monitor health care needs and more.
Telephone Learning Center
Got health questions? Answers to health questions are just a phone call away with the Telephone Learning Center™ (TLC) Line. This toll–free health information line is available for members 24 hours a day, 7 days a week. You can choose to talk with a nurse or select from recorded information covering more than 1,600 health topics.
Medication therapy management program
Members enrolled in Blue Medicare HMO may be eligible for the medication therapy management program (MTMP), in accordance with CMS requirements. The purpose of the program is to provide medication therapy management services to targeted members. These services are designed to ensure that covered Part D drugs are appropriately used to optimize therapeutic outcomes by improving medication use and reducing the risk of adverse drug events including adverse drug interactions. The MTMP is developed in cooperation with licensed and practicing pharmacists and physicians.