Frequently Asked Questions

If your company or union offers a group Medicare plan,  your Human Resources department or benefits administrator can give you all the details you need.

If they don't offer a group Medicare plan and you're looking for an individual Medicare plan, visit our shopping site.

Group Medicare plans may have richer benefits than individual plans. Many employers or unions offer a subsidy (defined contribution plan), which can lower your costs.

You can only be enrolled in one Medicare plan at a time. We can help as you move to your new plan.

Medicare Advantage plans, also called Medicare Part C, are plans offered by private health insurance companies like Blue Cross and Blue Shield of Texas and regulated by the government. These plans expand on the benefits of Medicare Parts A and B. For example, Blue Cross Group Medicare Advantage Open Access (PPO)℠ includes extra benefits like the SilverSneakers® Fitness Program, a 24-hour nurse advice line, and discount programs.

With Blue Cross Group Medicare Advantage Open Access (PPO), you can go to any providers who:

1. Accept Medicare
2. Agree to see you as a patient
3. Agree to bill the plan

They do not need to be part of any Blue Cross and Blue Shield network.

Members’ coverage levels are the same inside and outside their plan service area nationwide for covered benefits. Referrals aren’t required for office visits. Prior authorization may be required for certain services from Medicare Advantage-contracted providers with BCBSTX.

Note: Even Medicare-assigned providers can decide which patients they want to see, except in an emergency. We recommend that you confirm with providers that they will accept your Open Access PPO plan and file claims with the plan. Share the 'Your Providers, Your Personal Network' flyer with your providers. It explains your Open Access plan and how to submit claims.

Many companies offer these benefits to eligible retirees. Check with your benefit administrator for details about what is available to you.

If you enroll in a Group Retiree Medicare plan, your coverage cannot be canceled, your claims cannot be denied, nor can your premium be increased because of a pre-existing condition.

Yes. To participate in a Group Retiree Medicare plan you will continue to pay Part B premiums.

Your benefit administrator will provide directions. They may provide an enrollment kit or website for you to visit for more information about your options and instructions for enrolling.

No. However, enrollment in one of the group Medicare plans offered by your employer or union is required to qualify for a defined contribution (subsidy). If you decline retiree medical coverage, you may not be able to re-enroll yourself or your dependents later. Check with your benefit administrator to make sure you understand the consequences of declining coverage.

Under the Blue Cross Group Medicare Advantage (PPO) plan you can go to any provider that accepts Medicare; however, if you choose to see an out-of-network doctor, your costs may higher than if you’d chosen an in-network provider.

Under the Blue Cross Group Medicare Advantage Open Access (PPO)℠ plan, you can go to providers that:

1. Accept Medicare
2. Agree to see you as a patient
3. Agree to bill the Plan.

They do not need to be part of any Blue Cross and Blue Shield network.

All major national retail and grocery pharmacy chains participate in the BCBSTX pharmacy network. Search for pharmacies by ZIP code using the Pharmacy Finder or call customer service for help.

All network pharmacies offer members BCBSTX's contracted rates. You can spend less on your drug costs by shopping for the best price at any participating pharmacies or by using mail-order pharmacies. See the Helpful Tools page for details.