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Blue Medicare PPO
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Blue Medicare PPO gives you medical benefits and prescription drug coverage in one plan, for one premium. (You must continue to pay your Medicare Part B premium.) You can choose from two plans: one with our most robust medical and prescription drug benefits and another with our standard medical and prescription drug benefits.

A local company you can trust

Blue Options PPO is offered by PARTNERS National Health Plans of North Carolina, Inc., a subsidiary of Blue Cross and Blue Shield of North Carolina. Blue Medicare PPO is administered by BCBSNC. BCBSNC is a local company you can trust — with more than 70 years of experience in the health care industry.

Providers and specialists without a referral

As a Blue Medicare PPO member, you have the freedom to choose in- or out-of-network providers and specialists without a referral. While you need to select a primary care physician (PCP) to coordinate your care, you can still visit a doctor outside of the network; however, you will be responsible for more of the cost for out-of-network services.

Large network of pharmacies

You can fill your prescriptions at a large network of participating pharmacies throughout North Carolina. Most of the major chain pharmacies are part of our network, and you can fill your prescriptions at any of their locations nationwide. You can also fill your prescriptions through our mail order prescription program, which uses one of the largest network mail order pharmacies in the country.

Medicare prescription drug benefits

Blue Medicare PPO offers two plans, both with the same Medicare prescription drug benefits. Both the Enhanced PPO plan and the Enhanced Plus PPO plan include enhanced drug benefits. The enhanced drug benefit is more comprehensive than Medicare's 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 Blue Medicare PPO as a Medicare Advantage prescription drug plan because it includes medical coverage and prescription drug coverage. BCBSNC also offers stand-alone Medicare prescription drug plans - without medical coverage. Beneficiaries cannot enroll in a Medicare Advantage prescription drug plan and enroll in a stand-alone Medicare prescription drug plan at the same time.

Available in select counties in North Carolina:

Blue Medicare PPO is available in select counties across North Carolina within the service area approved by the Centers for Medicare & Medicaid Services (CMS).

ALAMANCECUMBERLANDIREDELLROCKINGHAM
ALEXANDERDAVIDSONJOHNSTONROWAN
ALLEGHANYDAVIEMECKLENBURGSTANLY
ASHEDURHAMNASHSTOKES
AVERYFORSYTHNORTHAMPTONSURRY
CABARRUSGASTONORANGEWAKE
CALDWELLGUILFORDPERSONWATAUGA
CASWELLHALIFAXRANDOLPHWILKES
CATAWBAHOKERICHMONDYADKIN
CHATHAM   

Health and wellness resources

Blue Medicare PPO offers a variety of health and wellness resources for members.

Health management programs
These programs are designed for people with specific chronic conditions, including:

  • Congestive heart failure
  • Diabetes
  • Coronary artery disease
  • Chronic obstructive pulmonary disease

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.

Case management
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 Centerâ„¢ (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 PPO 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.



Blue Medicare HMO and Blue Medicare PPO plans are offered by PARTNERS National Health Plans of North Carolina, Inc., a subsidiary of Blue Cross and Blue Shield of North Carolina (BCBSNC). PARTNERS is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. Plans are administered by BCBSNC. BCBSNC and PARTNERS do not discriminate based on color, gender, religion, national origin, age, race, disability, handicap, sexual orientation, genetic information, source of payment or health status as defined by the Centers for Medicare & Medicaid Services (CMS). All qualified Medicare beneficiaries 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 not otherwise paid for under Medicaid or another third party. BCBSNC and PARTNERS are independent licensees of the Blue Cross and Blue Shield Association.

™, Mark of PARTNERS National Health Plans of North Carolina,Inc.

®, SM Mark of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina.