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Important Plan Information

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You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Out-of-network/non-contracted providers are under no obligation to treat Blue Cross Medicare Advantage PPO members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the costsharing that applies to out-of-network services.

For Blue Cross Medicare Advantage Dual Care (HMO SNP)SM Plans:

This plan is available to anyone who has both Medical Assistance from the State and Medicare, and is enrolled in Blue Cross and Blue Shield of Texas' Medicaid plan.

Medicare Advantage Plan Notice:

HMO and HMO POS plans available in Texas: Atascosa, Bandera, Bastrop, Bexar, Burnet, Caldwell, Cameron, Chambers, Comal, El Paso, Fort Bend, Hardin, Harris, Hays, Hidalgo, Jefferson, Kendall, Lee, Liberty, Medina, Montgomery, Orange, Webb, Willacy, Williamson and Wilson. PPO plans available in the following Texas counties: Bastrop, Bexar, Burnet, Caldwell, Chambers, Collin, Dallas, Denton, Fayette, Fort Bend, Hardin, Harris, Hays, Jefferson, Lee, Liberty, Montgomery, Tarrant, Travis and Williamson.

Plans provided by Blue Cross and Blue Shield of Texas, which refers to HCSC Insurance Services Company (HISC) (PPO plans), and also to GHS Insurance Company (GHS) (HMO, HMO-POS and HMO Special Needs Plans). HISC and GHS are Independent Licensees of the Blue Cross and Blue Shield Association. HISC is a Medicare Advantage organization with a Medicare contract. GHS is a Medicare Advantage organization with a Medicare contract and a contract with the Texas Medicaid program. Enrollment in HISC’s and GHS’ plans depends on contract renewal.