How it works

Blue Medicare Rx coverage is insurance. We provide Medicare Prescriptions Drug Plans that allow you to take advantage of this insurance, which is partially paid for by Medicare.¹ You choose the Blue Medicare Rx Plan that’s right for you and pay a monthly premium. When you join, we inform Medicare and they help pay your drug costs.

Filling prescriptions

It’s easy to fill prescriptions with BCBSNC Blue Medicare Rx Plans. Just visit a network pharmacy, present your BCBSNC member ID card and pay the applicable copayment or coinsurance. There are virtually no claims to file.

Filling prescriptions out-of-town

Any network chain pharmacy that participates in our network within North Carolina is also considered in-network outside North Carolina. So, you may visit these stores nationwide and your prescription will be covered at the in-network rate.

Out-of-network coverage

If you visit an out-of-network pharmacy, except in emergency situations, your out-of-pocket costs may be higher. You will need to pay for your prescription at the pharmacy and file a claim for reimbursement. Review the specific out-of-network benefits offered by both of our drug coverage plans. More

Mail-order prescriptions

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.

Plan eligibility requirements

You must be entitled to Medicare Part A or enrolled in Part B to be eligible for Blue Medicare Rx coverage. You must also reside within our service area, which includes all 100 counties in North Carolina. Additionally, you may only enroll in one Blue Medicare Rx Plan at a time. If you are enrolled in a Medicare Advantage plan, you may not enroll in a Blue Medicare Rx Plan also, unless you are a member of a private fee-for-service Medicare Advantage plan, a Medical Savings Account plan, or a 1876 cost plan.

Specific enrollment period

Each year, from November 15 to December 31, eligible individuals may enroll in a Blue Medicare Rx Plan. If you are already enrolled in a plan, you may also switch to a different plan during this period. Coverage applied for during the enrollment period becomes effective January 1st of the following year.

If you turn 65, or otherwise become eligible during the year, you can apply at any time. If you do not enroll when you first become eligible, you may have to pay a late penalty when you do enroll.

Financial assistance

Extra help is available for people with limited income and resources. You can apply for extra help through the Social Security Administration or your State Medical Assistance Office. People who may qualify will receive an application from Social Security in the mail. To learn more about financial assistance, view our frequently asked questions.

Coverage determinations, appeals and grievances procedures

Review a description of our procedures for obtaining a coverage determination, or for appealing a coverage determination decision or for filing a grievance if you are dissatisfied for any reason. More

Quality assurance policies and procedures

Review the processes and systems we’ve put in place to evaluate prescriptions for health and safety issues. These procedures promote the appropriate use of medications by improving compliance and reducing medication errors and adverse drug interactions. More

Transition process

Learn under which circumstances a temporary supply of certain noncovered or nonformulary medications may be covered for new enrollees during the transition period onto our plan. More

Notice of possible contract termination

BCBSNC has a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare, to provide a Blue Medicare Rx plan. Learn how and when you will be informed if either BCBSNC or CMS decide to end the contract. More

Member rights and responsibilities

As a Medicare recipient, you have certain rights to help protect you. Learn more about your Medicare rights and protections as a BCBSNC member. Also provided are instructions for disenrolling from your plan, if you should decide to do so. More