Blue Cross Medicare Advantage Dual Care℠
Using Your Plan
Learn how to use your Blue Cross Medicare Advantage Dual Care℠ plan from Blue Cross and Blue Shield of Texas.
Using Your Blue Cross Med Advantage Dual Care Plus (HMO SNP)℠
We want you to get the most from your new plan. In this section, you’ll find resources to help you get started, maximize your benefits, use online tools, learn about claims and more.
Call us before calling Medicare. Because Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)℠ is your Medicare plan, you should call us with all your questions. Our Member Services team will let you know if your question can be answered by Medicare. Call the customer service number on your member ID card.
Welcome To Your Plan
- Enrollment Confirmation: Before you can start using your plan, Medicare must approve your enrollment. This will take about 10 business days. You’ll get an acknowledgment letter and a confirmation letter once approved. Your member ID card will be mailed next.
- Welcome Kit: Includes your plan’s drug formulary, the Evidence of Coverage form and other helpful information. Learn more about the Welcome Kit.
Finding a Provider
- Provider Search: To maximize benefits, use in-network providers. We can help you choose a primary care provider (PCP) in your plan's network. Search for a provider.
- Set up your Annual Wellness Visit once coverage is active.
Coinsurance and Copays
- Understanding Costs: Coinsurance is a percentage of the bill you pay. Copays are a set amount you pay at the time of service.
Prescription Drug Coverage
- Drug Formulary and Pharmacy Search: You will have online access to a Drug Formulary, which is a list of drugs that are covered. You can share the formulary with your doctor and talk about the drugs you take now. Learn more about your pharmacy options.
- Prior Authorization: Also, learn about how drugs are placed into tiers based on cost, prior authorization, quantity limits and more. Learn more about prior authorization.
- Drug Plan Transition: If you’re new to our plan, find out how to get a limited supply of your medication that isn’t covered Learn about drug plan transition.
- Medication Therapy Management: Find out if the drug you take is safe, works well and fits your lifestyle at no additional cost to eligible members. Learn more about medication therapy management.
- Medicare Prescription Payment Plan: This program can offer help with managing your out-of-pocket costs. Learn more about the Medicare Prescription Payment Plan.
Quick Facts About Claims and More
- Claims Filing: Your provider and pharmacist will usually file any claims for services or prescriptions you received. Once the claim is filed, you will get a statement called the Explanation of Benefits (EOB) from us. How often you receive it depends on how often you get care or fill your prescriptions.
- What is an EOB? The EOB is a statement, not a bill. It simply details what you have paid and indicates the level of benefits you’ve used.
- How to use an EOB: Review these to be sure they are correct. If you think there are errors on your EOB statement, or you think you are the victim of fraud, please call the number on the back of your member ID card.
Annual Notice of Change
You will get your Annual Notice of Change in October. This will tell you what changes will be made to your plan for the next year, starting January 1st. It will outline any expected premium or benefit changes.
MEDICARE ADVANTAGE DUAL CARE PLUS
Member Services
You have access to wellness programs, tools and resources to help you manage your health.
MEDICARE ADVANTAGE DUAL CARE PLUS
Extra Health and Wellness Benefits
Blue Cross Medicare Advantage Dual Plus plans offer a number of benefits above and beyond standard insurance benefits. The availability, cost and level of coverage can vary from plan to plan, so choose the plan that’s right for you.
Here are some of the extra health and wellness benefits offered with our plans.
Dental Coverage
Coverage for preventive and comprehensive dental care is available through some Blue Cross Medicare Advantage plans.
Find dental providers near you
Vision Coverage
Some plans include coverage for routine eye exams with an allowance toward frames and lenses or contact lenses.
Find vision providers near you
Hearing Coverage
Hearing is important to being present with your loved ones and friends. Some plans may provide coverage for hearing exams plus allowances or discounts on hearing aids.8
Visit the TruHearing® website1 MDLIVE operates and administers the Virtual Visit program and is solely responsible for its operations and that of its contracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission.
2 For medical emergencies, call 911. This program is not a substitute for a doctor’s care. Talk to your doctor about any health questions or concerns.
3 Convey Health Solutions, Inc. is an independent company that provides administrative services for over-the-counter supplemental benefits for Blue Cross and Blue Shield of Texas.
4 Blue365 is a discount program only for Blue Cross and Blue Shield of Texas members. This is NOT insurance. Discounts are only given through vendors that take part in this program. BCBSTX does not guarantee or make any claims or recommendations about the program’s services or products. BCBSTX reserves the right to stop or change this program at any time without notice. The relationship between the Blue365 vendors and BCBSTX is that of independent contractors. BCBSTX makes no endorsement, representations or warranties regarding any products or services they offer.
5 SilverSneakers® is a wellness program owned and operated by Tivity Health, Inc., an independent company. Tivity Health and SilverSneakers® are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries.
6 The benefits mentioned are Special Supplemental Benefits for the chronically ill (SSBCI). To be eligible for SSBCI benefits, you must have one or more of the following chronic conditions: cardiovascular disorders, chronic heart failure, diabetes, and stroke. Note that even if you have one or more of the listed chronic conditions, you are not guaranteed access to SSBCI benefits because other eligibility and coverage criteria also apply. Contact us to confirm eligibility for this benefit.
7 ModivCare Solutions, LLC, is an independent company that administers transportation services for Blue Cross and Blue Shield of Texas.
8 TruHearing is a registered trademark of TruHearing, Inc., which is an independent company providing discounts on hearing aids.