Using Your Medicare Plan
If you choose a Medicare Advantage plan from Blue Cross and Blue Shield of Texas, we’ll make sure you have the right resources to help you get the most from your plan. Understanding how it works and having the right resources can help. This section details how to find out what’s covered in the plan, how to file an appeal or grievance, download the formulary, search for a pharmacy, and more.
Is It Covered
It’s easy to ask questions or voice concerns about Medicare Advantage coverage. If you have questions about what the plan covers, you can:
- Check the Evidence of Coverage – This important notice is in the Welcome Kit we mail you shortly after you enroll. It details what the plan covers, how much you pay, and more. You can also find it on the Plan Documents page.
- Call customer service, and a representative can help you understand the plan benefits.
Medicare Organization/Coverage Determination, Appeals and Grievances
Blue Cross Medicare Advantage Plans have processes in place to address Medicare coverage issues, complaints and problems. If you have issues, complaints or problems with your Medicare plan or the care you receive, you have the right to make a complaint. You can find more information on the Medical Care Appeals and Grievances page and on the Drug Coverage, Appeals and Grievances page.
Drugs covered by Blue Cross Medicare Advantage Dual Care are listed in formularies (drug lists). Each plan has its own drug list. The drug lists include generic and brand name drugs. They also have information about drug copays and limitations such as prior authorization, quantity limits and step therapy.
Drug lists can change. Most of the changes in the Drug List are new for the beginning of each year. However, during the year, we might make other changes that are allowed by Medicare rules. We will provide you with advance notice of these changes.
Use the Drug Finder tool to find the most up-to-date list of medicines covered by each plan.
You can download your formulary for immediate access on our Forms & Documents page.
If you need assistance with additional plan documents, please contact us.
Prior Authorization/Utilization Management
Drug Plan Transition
Medication Therapy Management
If you would like to submit feedback directly to Medicare, please use the Medicare Complaint Form or contact the Office of the Medicare Ombudsman.