2008 Plan details

Blue Medicare HMO gives you quality coverage within a network of doctors and specialists. The enhanced plan includes our most robust medical benefits and is available with or without Medicare prescription drug benefits. The standard benefit plan is also available with standard prescription drug coverage.

A local company you can trust

Blue Medicare HMO is offered by PARTNERS National Health Plans of North Carolina, Inc., a subsidiary of Blue Cross and Blue Shield of North Carolina. PARTNERS was the first Medicare Advantage organization in North Carolina. PARTNERS is an HMO with a Medicare contract.

Network of doctors

Blue Medicare HMO has a network of contracted doctors for you to use. You can select a primary care physician (PCP) from within the Blue Medicare HMO network to coordinate your care. You can select a family practice, general practice or internal medicine doctor as your PCP. Although it is not required that you visit your PCP before visiting a specialist, it is strongly encouraged. Your PCP can help ensure that you receive coordinated health care by referring you for tests, hospital stays or specialist consultations.

There is no penalty for visiting a specialist on your own without a referral from your PCP. However, the cost of a specialist visit is greater than the cost of a PCP visit. Your PCP can help ensure that you need a specialist visit.

If you see a doctor outside the network, except in emergency or urgent care situations or for out-of-area renal dialysis care, neither Medicare, nor PARTNERS will be responsible for the costs.

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 the network, and you can fill your prescriptions at any of their locations nationwide. You can also fill your prescriptions through the mail order prescription program, which uses one of the largest network mail order pharmacies in the country. More

Learn more about Medicare prescription drug benefits with Blue Medicare HMO.

Available in select counties in North Carolina

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

Alamance	Cumberland	Johnston	Stanly
Alexander	Davidson	Mecklenburg	Stokes
Alleghany	Davie	Nash	Surry
Ashe	Durham	Northampton	Wake
Avery	Forsyth	Orange	Watauga
Cabarrus	Gaston	Person	Wilkes
Caldwell	Guilford	Randolph	Yadkin
Caswell	Halifax	Richmond
Catawba	Hoke	Rockingham
Chatham	Iredell	Rowan

No age limitation

There is no age limitation for Blue Medicare HMO plans. If you have a pre-existing condition you can enroll without a waiting period if you meet the following requirements (See below). Individuals who receive their Medicare benefits through disability are also eligible.

To be eligible to enroll in a Blue Medicare HMO plan, you must:

• Be entitled to Medicare Part A and enrolled in Medicare Part B
• Reside in our CMS-approved service area (see counties above)

Note: Due to federal regulations, you may not be eligible to join Blue Medicare HMO if you are medically determined to have End Stage Renal Disease – unless you meet exception qualifications. Please contact Blue Medicare HMO for more information.

Health and wellness resources

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

Health management programs
These programs are available for people with specific chronic conditions.

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
Do you have 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
The Medication Therapy Management Program assists members who have been identified by the Plan as taking multiple medications for the treatment of certain medical conditions. The program helps members to understand better how to take their medicines safely and effectively. The Plan provides information to assist members to avoid potential medical complications related to their medicines and to help members take their medicines the way their doctor has prescribed.